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Lessard LM, Puhl RM, Foster GD, Cardel MI. Parent-Adolescent Weight Communication: Parental Psychosocial Correlates Among a Diverse National Sample. J Health Commun 2024; 29:167-173. [PMID: 38230988 DOI: 10.1080/10810730.2023.2276797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Parental communication about body weight with their children is common across diverse families. The current study investigates how parents' feelings about their own bodies, beliefs about body weight, history of weight stigma, and weight-related characteristics contribute to the degree to which they talk about weight - both negatively and positively - with their adolescent children. The study sample was comprised of U.S. parents (N = 1936) from diverse racial/ethnic backgrounds with children aged 10-17 years old. Parents completed an online survey with measures assessing their frequency of engaging in negative and positive weight communication with their children, along with several relevant psychosocial factors (i.e. body satisfaction, experienced weight stigma, associative stigma, body appreciation, beliefs about weight controllability, weight bias internalization). Study findings paint a complex picture, including some psychosocial factors (e.g. weight bias internalization) that are related to both more frequent negative and positive weight communication. Notably, higher levels of associative stigma were related to more frequent negative parental weight comments, and less frequent positive weight socialization. Findings can inform healthcare professionals in raising parents' awareness about how their personal beliefs and feelings about their own weight and their child's weight can contribute to how they engage in communication about weight with their children.
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Affiliation(s)
- Leah M Lessard
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Gary D Foster
- WW International, Inc, New York, New York, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle I Cardel
- WW International, Inc, New York, New York, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
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2
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Chao AM, Wadden TA, Cao W, Zhou Y, Maldonado D, Cardel MI, Foster GD, Loughead J. Randomized Controlled Trial of Effects of Behavioral Weight Loss Treatment on Food Cue Reactivity. Nurs Res 2024; 73:91-100. [PMID: 37916843 PMCID: PMC10922238 DOI: 10.1097/nnr.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND It is not known whether behavioral weight loss can attenuate blood oxygen level-dependent responses to food stimuli. OBJECTIVES This randomized controlled trial assessed the effects of a commercially available behavioral weight loss program (WW, WeightWatchers) compared to a wait-list control on blood oxygen level-dependent response to food cues. METHODS Females with obesity ( N = 61) were randomized to behavioral weight loss or wait-list control. At baseline and follow-up, participants completed assessments that included functional magnetic resonance imaging scans to assess response to images of high-calorie foods (HCF) or low-calorie foods (LCF), and neutral objects. RESULTS There were no significant between-group differences in change from baseline to follow-up in any regions of the brain in response to viewing HCF or LCF. From baseline to follow-up, participants in behavioral weight loss, compared with wait-list control, reported significantly greater increases in desire for LCF. Changes in liking and palatability of LCF and liking, palatability, and desire for HCF did not differ between groups. DISCUSSION Behavioral weight loss was associated with increased desire for LCF without changes in neural reactivity to food cues. These results suggest that alteration of neurological processes underlying responsiveness to food is difficult to achieve through behavioral weight management alone.
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Tong J, Duan R, Li R, Luo C, Moore JH, Zhu J, Foster GD, Volpp KG, Yancy WS, Shaw PA, Chen Y. Publisher Correction: Quantifying and correcting bias due to outcome dependent self-reported weights in longitudinal study of weight loss interventions. Sci Rep 2023; 13:22546. [PMID: 38110504 PMCID: PMC10728146 DOI: 10.1038/s41598-023-49737-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Affiliation(s)
- Jiayi Tong
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Rui Duan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Ruowang Li
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Jason H Moore
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Gary D Foster
- WW International, New York, NY, 10010, USA
- Center for Weight and eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kevin G Volpp
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - William S Yancy
- Department of Medicine, Duke University, Durham, NC, 27705, USA
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Jelalian E, Darling K, Foster GD, Runyan T, Cardel MI. Effectiveness of a Scalable mHealth Intervention for Children With Overweight and Obesity. Child Obes 2023; 19:552-559. [PMID: 36576892 DOI: 10.1089/chi.2022.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Multicomponent interventions are the first line of treatment for pediatric obesity, but are challenging to access. Mobile health (mHealth) interventions hold promise as they address commonly cited barriers for attending in person programs and have potential for wide scale dissemination. Methods: This retrospective cohort study examined data from youth who enrolled in the Kurbo program, which includes personal health coaching and a mobile app. Hierarchical linear regression was used to examine the impact of baseline percentage of the 95th% percentile for body mass index (%BMIp95), number of coaching sessions, and length of time enrolled in the program on change in %BMIp95, controlling for baseline age and sex. Results: A total of 3500 youth (mean age of 12.79 years, 71.3% female) were included. Youth experienced a 0.70 U decrease in BMI [standard deviation (SD) = 2.19] and a 4.45% decrease (SD = 8.5) in %BMIp95 over a mean of 31.5 weeks. The overall regression model was significant, R2 = 0.066, F(3,3494) = 77.18, and p < 0.001. Predictors of decrease in weight status included being female (b = -1.11, p < 0.001), higher baseline %BMIp95, (b = -0.58, p < 0.001), and greater number of coaching sessions (b = -0.12, p < 0.001), while greater time enrolled in the program (b = 0.02, p < 0.001) was associated with less change. Conclusion: Findings suggest a scalable coaching program with integrated digital tools for monitoring diet and activity can lead to significant reductions in weight status. Findings need to be replicated with more rigorous study designs, including a comparison condition and verified assessment of height and weight.
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Affiliation(s)
- Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Katherine Darling
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- WW International, Inc., New York, NY, USA
| | | | - Michelle I Cardel
- WW International, Inc., New York, NY, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
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Flanagan EW, Spann R, Berry SE, Berthoud HR, Broyles S, Foster GD, Krakoff J, Loos RJF, Lowe MR, Ostendorf DM, Powell-Wiley TM, Redman LM, Rosenbaum M, Schauer PR, Seeley RJ, Swinburn BA, Hall K, Ravussin E. New insights in the mechanisms of weight-loss maintenance: Summary from a Pennington symposium. Obesity (Silver Spring) 2023; 31:2895-2908. [PMID: 37845825 PMCID: PMC10915908 DOI: 10.1002/oby.23905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 10/18/2023]
Abstract
Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long-term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight-loss maintenance, and systems-level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight-reduced state.
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Affiliation(s)
| | - Redin Spann
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sarah E. Berry
- Department of Nutritional Sciences, King’s College London, London, UK
| | | | | | - Gary D. Foster
- WW International, New York, New York, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan Krakoff
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology & Clinical Research Branch, NIDDK-Phoenix, Phoenix, Arizona, USA
| | - Ruth J. F. Loos
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Danielle M. Ostendorf
- Department of Medicine, Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Leanne M. Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Michael Rosenbaum
- Division of Molecular Genetics and Irving Center for Clinical and Translational Research, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Randy J. Seeley
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Boyd A. Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kevin Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Tong J, Duan R, Li R, Luo C, Moore JH, Zhu J, Foster GD, Volpp KG, Yancy WS, Shaw PA, Chen Y. Quantifying and correcting bias due to outcome dependent self-reported weights in longitudinal study of weight loss interventions. Sci Rep 2023; 13:19078. [PMID: 37925516 PMCID: PMC10625563 DOI: 10.1038/s41598-023-41853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/31/2023] [Indexed: 11/06/2023] Open
Abstract
In response to the escalating global obesity crisis and its associated health and financial burdens, this paper presents a novel methodology for analyzing longitudinal weight loss data and assessing the effectiveness of financial incentives. Drawing from the Keep It Off trial-a three-arm randomized controlled study with 189 participants-we examined the potential impact of financial incentives on weight loss maintenance. Given that some participants choose not to weigh themselves because of small weight change or weight gains, which is a common phenomenon in many weight-loss studies, traditional methods, for example, the Generalized Estimating Equations (GEE) method tends to overestimate the effect size due to the assumption that data are missing completely at random. To address this challenge, we proposed a framework which can identify evidence of missing not at random and conduct bias correction using the estimating equation derived from pairwise composite likelihood. By analyzing the Keep It Off data, we found that the data in this trial are most likely characterized by non-random missingness. Notably, we also found that the enrollment time (i.e., duration time) would be positively associated with the weight loss maintenance after adjusting for the baseline participant characteristics (e.g., age, sex). Moreover, the lottery-based intervention was found to be more effective in weight loss maintenance compared with the direct payment intervention, though the difference was non-statistically significant. This framework's significance extends beyond weight loss research, offering a semi-parametric approach to assess missing data mechanisms and robustly explore associations between exposures (e.g., financial incentives) and key outcomes (e.g., weight loss maintenance). In essence, the proposed methodology provides a powerful toolkit for analyzing real-world longitudinal data, particularly in scenarios with data missing not at random, enriching comprehension of intricate dataset dynamics.
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Affiliation(s)
- Jiayi Tong
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Rui Duan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Ruowang Li
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Jason H Moore
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Gary D Foster
- WW International, New York, NY, 10010, USA
- Center for Weight and eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kevin G Volpp
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - William S Yancy
- Department of Medicine, Duke University, Durham, NC, 27705, USA
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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7
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Phelan S, Cardel MI, Lee AM, Alarcon N, Foster GD. Behavioral, psychological, and environmental predictors of weight regain in a group of successful weight losers in a widely available weight-management program. Obesity (Silver Spring) 2023; 31:2709-2719. [PMID: 37840409 DOI: 10.1002/oby.23903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The aim of this study was to identify predictors of weight regain and continued weight maintenance among individuals already successful at long-term weight loss in a widely available weight-management program. METHODS Participants were 2843 weight-loss maintainers in WeightWatchers who had maintained weight loss ≥9.1 kg for ≥1 year (average 25.5 kg for 3.5 years; BMI = 26.7 kg/m2 ). Validated behavioral, psychosocial, and home environmental questionnaires were administered at study entry and 1 year later. Discriminant analysis identified variables that discriminated gainers (≥2.3-kg gain) from maintainers (±2.3-kg change). RESULTS Over the 1 year of follow-up, 43% were gainers (mean [SD], 7.2 [5.4] kg), and 57% were maintainers (0.4 [1.2] kg). Compared with maintainers, gainers were younger and had higher initial weight, more recent weight losses, and larger initial weight losses. Standardized canonical coefficients indicated that the 1-year changes that most discriminated gainers from maintainers were greater decreases in the ability to accept uncomfortable food cravings, urges, and desires to overeat (0.232); self-monitoring (0.166); body image (0.363); and body satisfaction (0.194) and greater increases in disinhibition (0.309) and bodily pain (0.147). The canonical correlation was 0.505 (p < 0.001). CONCLUSIONS Future interventions to prevent regain should consider targeting overeating in response to internal and external food cues and declines in self-monitoring and body image.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Michelle I Cardel
- WW International, Inc., New York, New York, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Noemi Alarcon
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Gary D Foster
- WW International, Inc., New York, New York, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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8
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Höchsmann C, Yang S, Ordovás JM, Dorling JL, Champagne CM, Apolzan JW, Greenway FL, Cardel MI, Foster GD, Martin CK. The Personalized Nutrition Study (POINTS): evaluation of a genetically informed weight loss approach, a Randomized Clinical Trial. Nat Commun 2023; 14:6321. [PMID: 37813841 PMCID: PMC10562431 DOI: 10.1038/s41467-023-41969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023] Open
Abstract
Weight loss (WL) differences between isocaloric high-carbohydrate and high-fat diets are generally small; however, individual WL varies within diet groups. Genotype patterns may modify diet effects, with carbohydrate-responsive genotypes losing more weight on high-carbohydrate diets (and vice versa for fat-responsive genotypes). We investigated whether 12-week WL (kg, primary outcome) differs between genotype-concordant and genotype-discordant diets. In this 12-week single-center WL trial, 145 participants with overweight/obesity were identified a priori as fat-responders or carbohydrate-responders based on their combined genotypes at ten genetic variants and randomized to a high-fat (n = 73) or high-carbohydrate diet (n = 72), yielding 4 groups: (1) fat-responders receiving high-fat diet, (2) fat-responders receiving high-carbohydrate diet, (3) carbohydrate-responders receiving high-fat diet, (4) carbohydrate-responders receiving high-carbohydrate diet. Dietitians delivered the WL intervention via 12 weekly diet-specific small group sessions. Outcome assessors were blind to diet assignment and genotype patterns. We included 122 participants (54.4 [SD:13.2] years, BMI 34.9 [SD:5.1] kg/m2, 84% women) in the analyses. Twelve-week WL did not differ between the genotype-concordant (-5.3 kg [SD:1.0]) and genotype-discordant diets (-4.8 kg [SD:1.1]; adjusted difference: -0.6 kg [95% CI: -2.1,0.9], p = 0.50). With the current ability to genotype participants as fat- or carbohydrate-responders, evidence does not support greater WL on genotype-concordant diets. ClinicalTrials identifier: NCT04145466.
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Affiliation(s)
- Christoph Höchsmann
- Department of Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Shengping Yang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - James L Dorling
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life of Sciences, University of Glasgow, Glasgow, UK
| | | | - John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Michelle I Cardel
- WW International, Inc., New York, NY, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Gary D Foster
- WW International, Inc., New York, NY, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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9
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Sahu N, Indic B, Wong-Bajracharya J, Merényi Z, Ke HM, Ahrendt S, Monk TL, Kocsubé S, Drula E, Lipzen A, Bálint B, Henrissat B, Andreopoulos B, Martin FM, Bugge Harder C, Rigling D, Ford KL, Foster GD, Pangilinan J, Papanicolaou A, Barry K, LaButti K, Virágh M, Koriabine M, Yan M, Riley R, Champramary S, Plett KL, Grigoriev IV, Tsai IJ, Slot J, Sipos G, Plett J, Nagy LG. Vertical and horizontal gene transfer shaped plant colonization and biomass degradation in the fungal genus Armillaria. Nat Microbiol 2023; 8:1668-1681. [PMID: 37550506 PMCID: PMC7615209 DOI: 10.1038/s41564-023-01448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/11/2023] [Indexed: 08/09/2023]
Abstract
The fungal genus Armillaria contains necrotrophic pathogens and some of the largest terrestrial organisms that cause tremendous losses in diverse ecosystems, yet how they evolved pathogenicity in a clade of dominantly non-pathogenic wood degraders remains elusive. Here we show that Armillaria species, in addition to gene duplications and de novo gene origins, acquired at least 1,025 genes via 124 horizontal gene transfer events, primarily from Ascomycota. Horizontal gene transfer might have affected plant biomass degrading and virulence abilities of Armillaria, and provides an explanation for their unusual, soft rot-like wood decay strategy. Combined multi-species expression data revealed extensive regulation of horizontally acquired and wood-decay related genes, putative virulence factors and two novel conserved pathogenicity-induced small secreted proteins, which induced necrosis in planta. Overall, this study details how evolution knitted together horizontally and vertically inherited genes in complex adaptive traits of plant biomass degradation and pathogenicity in important fungal pathogens.
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Affiliation(s)
- Neha Sahu
- Biological Research Center, Synthetic and Systems Biology Unit, Szeged, Hungary
- Doctoral School of Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Boris Indic
- Functional Genomics and Bioinformatics Group, Faculty of Forestry, Institute of Forest and Natural Resource Management, University of Sopron, Sopron, Hungary
| | - Johanna Wong-Bajracharya
- Hawkesbury Institute for the Environment, Western Sydney University, Richmond, New South Wales, Australia
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, New South Wales, Australia
| | - Zsolt Merényi
- Biological Research Center, Synthetic and Systems Biology Unit, Szeged, Hungary
| | - Huei-Mien Ke
- Biodiversity Research Center, Academia Sinica, Taipei, Taiwan
- Department of Microbiology, Soochow University, Taipei, Taiwan
| | - Steven Ahrendt
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Tori-Lee Monk
- Hawkesbury Institute for the Environment, Western Sydney University, Richmond, New South Wales, Australia
| | - Sándor Kocsubé
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
- ELKH-SZTE Fungal Pathogenicity Mechanisms Research Group, University of Szeged, Szeged, Hungary
| | - Elodie Drula
- Architecture et Fonction des Macromolécules Biologiques (AFMB), CNRS, Aix-Marseille Université, Marseille, France
- INRAE, UMR 1163, Biodiversité et Biotechnologie Fongiques, Marseille, France
| | - Anna Lipzen
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Balázs Bálint
- Biological Research Center, Synthetic and Systems Biology Unit, Szeged, Hungary
| | - Bernard Henrissat
- DTU Bioengineering, Technical University of Denmark, Kongens Lyngby, Denmark
- Department of Biological Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bill Andreopoulos
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Francis M Martin
- Université de Lorraine, INRAE, UMR 1136 'Interactions Arbres/Microorganismes', Centre INRAE Grand Est - Nancy, Champenoux, France
| | - Christoffer Bugge Harder
- Department of Biology, Section of Terrestrial Ecology, University of Copenhagen, København Ø, Denmark
- Department of Biosciences, University of Oslo, Blindern, Oslo, Norway
| | - Daniel Rigling
- Swiss Federal Research Institute WSL, Birmensdorf, Switzerland
| | - Kathryn L Ford
- School of Biological Sciences, Life Sciences Building, University of Bristol, Bristol, UK
| | - Gary D Foster
- School of Biological Sciences, Life Sciences Building, University of Bristol, Bristol, UK
| | - Jasmyn Pangilinan
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Alexie Papanicolaou
- Hawkesbury Institute for the Environment, Western Sydney University, Richmond, New South Wales, Australia
| | - Kerrie Barry
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Kurt LaButti
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Máté Virágh
- Biological Research Center, Synthetic and Systems Biology Unit, Szeged, Hungary
| | - Maxim Koriabine
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Mi Yan
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Robert Riley
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Simang Champramary
- Doctoral School of Biology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
- Functional Genomics and Bioinformatics Group, Faculty of Forestry, Institute of Forest and Natural Resource Management, University of Sopron, Sopron, Hungary
| | - Krista L Plett
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, New South Wales, Australia
| | - Igor V Grigoriev
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
- Department of Plant and Microbial Biology, University of California Berkeley, Berkeley, CA, USA
| | | | - Jason Slot
- Department of Plant Pathology, The Ohio State University, Columbus, OH, USA
| | - György Sipos
- Functional Genomics and Bioinformatics Group, Faculty of Forestry, Institute of Forest and Natural Resource Management, University of Sopron, Sopron, Hungary
| | - Jonathan Plett
- Hawkesbury Institute for the Environment, Western Sydney University, Richmond, New South Wales, Australia
| | - László G Nagy
- Biological Research Center, Synthetic and Systems Biology Unit, Szeged, Hungary.
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10
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Pagoto S, Xu R, Bullard T, Foster GD, Bannor R, Arcangel K, DiVito J, Schroeder M, Cardel MI. An Evaluation of a Personalized Multicomponent Commercial Digital Weight Management Program: Single-Arm Behavioral Trial. J Med Internet Res 2023; 25:e44955. [PMID: 37642986 PMCID: PMC10498321 DOI: 10.2196/44955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/20/2023] [Accepted: 06/30/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Digital behavioral weight loss programs are scalable and effective, and they provide an opportunity to personalize intervention components. However, more research is needed to test the acceptability and efficacy of personalized digital behavioral weight loss interventions. OBJECTIVE In a 6-month single-arm trial, we examined weight loss, acceptability, and secondary outcomes of a digital commercial weight loss program (WeightWatchers). This digital program included a personalized weight loss program based on sex, age, height, weight, and personal food preferences, as well as synchronous (eg, virtual workshops and individual weekly check-ins) and asynchronous (eg, mobile app and virtual group) elements. In addition to a personalized daily and weekly PersonalPoints target, the program provided users with personalized lists of ≥300 ZeroPoint foods, which are foods that do not need to be weighed, measured, or tracked. METHODS We conducted a pre-post evaluation of this 6-month, digitally delivered, and personalized WeightWatchers weight management program on weight loss at 3 and 6 months in adults with overweight and obesity. The secondary outcomes included participation, satisfaction, fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, self-compassion, well-being, and behavioral automaticity. RESULTS Of the 153 participants, 107 (69.9%) were female, and 65 (42.5%) identified as being from a minoritized racial or ethnic group. Participants' mean age was 41.09 (SD 13.78) years, and their mean BMI was 31.8 (SD 5.0) kg/m2. Participants had an average weight change of -4.25% (SD 3.93%) from baseline to 3 months and -5.05% (SD 5.59%) from baseline to 6 months. At 6 months, the percentages of participants who experienced ≥3%, ≥5%, and ≥10% weight loss were 63.4% (97/153), 51% (78/153), and 14.4% (22/153), respectively. The mean percentage of weeks in which participants engaged in ≥1 aspects of the program was 87.53% (SD 23.40%) at 3 months and 77.67% (SD 28.69%) at 6 months. Retention was high (132/153, 86.3%), and more than two-thirds (94/140, 67.1%) of the participants reported that the program helped them lose weight. Significant improvements were observed in fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, and well-being (all P values <.01). CONCLUSIONS This personalized, digital, and scalable behavioral weight management program resulted in clinically significant weight loss in half (78/153, 51%) of the participants as well as improvements in behavioral and psychosocial outcomes. Future research should compare personalized digital weight loss programs with generic programs on weight loss, participation, and acceptability.
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Affiliation(s)
- Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Ran Xu
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | | | | | - Richard Bannor
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Kaylei Arcangel
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Joseph DiVito
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Matthew Schroeder
- Center for Aging Research, Regenstrief Institute, Indianapolis, IN, United States
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11
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Lessard LM, Puhl RM, Foster GD, Cardel MI. Parental Communication About Body Weight and Adolescent Health: The Role of Positive and Negative Weight-Related Comments. J Pediatr Psychol 2023; 48:700-706. [PMID: 37377019 DOI: 10.1093/jpepsy/jsad040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE Research has consistently documented adverse effects of parent weight-related comments on adolescent health. However, little empirical attention has focused on isolating the impact of weight-related comments from mothers versus fathers, and the valence of their comments. The present study examined the extent to which positive and negative weight-related comments from mothers and fathers are related to adolescent health and wellbeing, and whether these associations differ according to adolescent sociodemographic characteristics. METHODS Data were collected from a diverse sample of 2032 U.S.-based adolescents aged 10-17 years (59% female; 40% White, 25% Black or African American, 23% Latinx). Online questionnaires assessed perceived frequency of negative and positive weight-related comments from mothers and fathers, as well as four indicators of adolescent health and wellbeing: depression, unhealthy weight control behaviors, weight bias internalization (WBI), and body appreciation. RESULTS More frequent negative weight-related comments from parents were associated with poorer adolescent health and wellbeing, while positive comments contributed to lower levels of WBI and body appreciation; these associations were documented regardless of whether mothers or fathers were the source of such comments, and considerable consistency was demonstrated across adolescent sociodemographic characteristics. CONCLUSION Findings highlight differences in adolescent health based on how parents discuss their body weight (i.e., negatively or positively), and similarity in associations regardless of whether mothers or fathers are the source of weight communication. These findings reiterate the importance of efforts to educate parents on ways to engage in supportive communication about weight-related health with their children.
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Affiliation(s)
- Leah M Lessard
- Rudd Center for Food Policy and Health, University of Connecticut, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy and Health, University of Connecticut, USA
- Department of Human Development and Family Sciences, University of Connecticut, USA
| | - Gary D Foster
- WW International, Inc, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - Michelle I Cardel
- WW International, Inc, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, USA
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12
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Bailey-Davis L, Pinto AM, Hanna DJ, Cardel MI, Rethorst CD, Matta K, Still CD, Foster GD. Qualitative inquiry with persons with obesity about weight management in primary care and referrals. Front Public Health 2023; 11:1190443. [PMID: 37601225 PMCID: PMC10435859 DOI: 10.3389/fpubh.2023.1190443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Referrals to evidence-based weight management in the community-commercial sector are aligned with clinical recommendations but underutilized. Methods This qualitative study explored patients' perceptions and expectations about obesity treatment in primary care and referral to community-commercial sector programs. Individual semi-structured interviews were conducted with a sample of US persons with obesity via telephone. Audiotape transcripts, interviewer notes, and independent review of data by two investigators allowed for data and investigator triangulation. Transcripts were analyzed using thematic analysis. Results Data saturation was reached with 30 participants who had a mean age of 41.6 years (SD 9.4), 37% male, 20% Black/African American and 17% Hispanic, 57% college educated, and 50% were employed full-time. Three primary themes emerged: (1) frustration with weight management in primary care; (2) patients expect providers to be better informed of and offer treatment options; and (3) opportunities and challenges with referrals to community-commercial programs. Discussion Patients expect that providers offer personalized treatment options and referrals to effective community-commercial programs are an acceptable option. If patient-level data are shared between clinical and community entities to facilitate referrals, then privacy and security issues need attention. Future research is needed to determine feasibility of implementing clinical to community-commercial referrals for obesity treatment in the United States.
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Affiliation(s)
- Lisa Bailey-Davis
- Department of Population Health Sciences, Geisinger, Danville, PA, United States
- Center for Obesity and Metabolic Research, Geisinger, Danville, PA, United States
| | | | - David J. Hanna
- Center for Obesity and Metabolic Research, Geisinger, Danville, PA, United States
| | | | - Chad D. Rethorst
- Institute for Advancing Health through Agriculture, Texas A&M Agrilife Dallas Center, Dallas, TX, United States
| | - Kelsey Matta
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Christopher D. Still
- Center for Obesity and Metabolic Research, Geisinger, Danville, PA, United States
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Gary D. Foster
- WW International, Inc., New York, NY, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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13
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Xu R, Bannor R, Cardel MI, Foster GD, Pagoto S. How much food tracking during a digital weight-management program is enough to produce clinically significant weight loss? Obesity (Silver Spring) 2023. [PMID: 37271576 DOI: 10.1002/oby.23795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/23/2023] [Accepted: 04/15/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The aim of this study was to identify the levels of food-tracking adherence that best predict ≥3%, ≥5%, and ≥10% weight loss at 6 months and to identify distinctive food-tracking trajectories among participants in a 6-month, commercial digital weight-management program. METHODS This study used data from 153 participants of a single-arm trial of a commercial digital weight-management program, WeightWatchers (WW). Receiver operating characteristic (ROC) curve analysis was conducted to identify the optimum thresholds of food tracking that can predict ≥3%, ≥5%, and ≥10% weight loss at 6 months. Time series clustering analysis was performed on weekly food-tracking data to identify trajectories and compare trajectories on weight loss at 6 months. RESULTS ROC analyses showed that the optimum thresholds of food tracking were 28.5% of the intervention days to achieve ≥3% weight loss (area under the curve [AUC] = 0.820, p < 0.001), 39.4% to achieve ≥5% weight loss (AUC = 0.744, p < 0.001), and 67.1% to achieve 10% weight loss (AUC = 0.712, p = 0.002). Time series clustering analyses found three food-tracking trajectories. Trajectories differed significantly in weight loss at 6 months (F = 14.1, p < 0.001). CONCLUSIONS Results suggest that perfect food-tracking adherence is not necessary to achieve clinically significant weight loss.
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Affiliation(s)
- Ran Xu
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Richard Bannor
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Michelle I Cardel
- WW International, Inc., New York, New York, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Gary D Foster
- WW International, Inc., New York, New York, USA
- Center for Weight and Eating Disorders Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
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14
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Lawrence SE, Puhl RM, Watson RJ, Schwartz MB, Lessard LM, Foster GD. Family-based weight stigma and psychosocial health: A multinational comparison. Obesity (Silver Spring) 2023; 31:1666-1677. [PMID: 37171908 DOI: 10.1002/oby.23748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/10/2023] [Accepted: 01/24/2023] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Family-based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family-based weight stigma among adult members of a weight-management program living in Australia, Canada, France, Germany, the UK, and the US. METHODS Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self-rated health. RESULTS Family-based weight stigma, especially from mothers (49%-62%), spouses/romantic partners (40%-57%), and fathers (35%-48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (β coefficients = |0.08-0.13|). CONCLUSIONS Findings highlight the need for weight stigma-reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight-stigmatizing communication. Future research should examine the prevalence and correlates of family-based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non-Western countries.
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Affiliation(s)
- Samantha E Lawrence
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Marlene B Schwartz
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Leah M Lessard
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Gary D Foster
- WW International, Inc., New York, New York, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Chao AM, Zhou Y, Erus G, Davatzikos C, Cardel MI, Foster GD, Wadden TA. A randomized controlled trial examining the effects of behavioral weight loss treatment on hippocampal volume and neurocognition. Physiol Behav 2023; 267:114228. [PMID: 37156318 DOI: 10.1016/j.physbeh.2023.114228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/20/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND/PURPOSE Obesity in midlife is an established risk factor for dementia. In middle-aged adults, elevated body mass index (BMI) is associated with lower neurocognition and smaller hippocampal volumes. It is unclear whether behavioral weight loss (BWL) can improve neurocognition. The purpose of this study was to evaluate whether BWL, compared to wait list control (WLC), improved hippocampal volume and neurocognition. We also examined if baseline hippocampal volume and neurocognition were associated with weight loss. METHODS We randomly assigned women with obesity (N=61; mean±SD age=41.1±9.9 years; BMI=38.6±6.2 kg/m2; and 50.8% Black) to BWL or WLC. Participants completed assessments at baseline and follow-up including T1-weighted structural magnetic resonance imaging scans and the National Institutes of Health (NIH) Toolbox Cognition Battery. RESULTS The BWL group lost 4.7±4.9% of initial body weight at 16 to 25 weeks, which was significantly more than the WLC group which gained 0.2±3.5% (p<0.001). The BWL and WLC groups did not differ significantly in changes in hippocampal volume or neurocognition (ps>0.05). Baseline hippocampal volume and neurocognition scores were not significantly associated with weight loss (ps>0.05). CONCLUSIONS AND IMPLICATIONS Contrary to our hypothesis, we found no overall benefit of BWL relative to WLC on hippocampal volumes or cognition in young- and middle-aged women. Baseline hippocampal volume and neurocognition were not associated with weight loss.
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Affiliation(s)
- Ariana M Chao
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA.
| | - Yingjie Zhou
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
| | - Guray Erus
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA; University of Pennsylvania, Center for Biomedical Image Computing and Analytics, Philadelphia, PA, USA
| | - Christos Davatzikos
- University of Pennsylvania, Center for Biomedical Image Computing and Analytics, Philadelphia, PA, USA
| | - Michelle I Cardel
- WW International, Inc., New York, New York, USA; Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Gary D Foster
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA; WW International, Inc., New York, New York, USA
| | - Thomas A Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
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16
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Apolzan JW, LaRose JG, Anton SD, Beyl RA, Greenway FL, Wickham EP, Lanoye A, Harris MN, Martin CK, Bullard T, Foster GD, Cardel MI. A scalable, virtual weight management program tailored for adults with type 2 diabetes: effects on glycemic control. Nutr Diabetes 2023; 13:3. [PMID: 37024467 PMCID: PMC10079927 DOI: 10.1038/s41387-023-00234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/12/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND The objective was to test the efficacy of a scalable, virtually delivered, diabetes-tailored weight management program on glycemic control in adults with type 2 diabetes (T2D). METHODS This was a single arm, three-site clinical trial. Participants had baseline HbA1c between 7-11% and BMI between 27-50 kg/m2. Primary outcome was change in HbA1c at 24 weeks. Secondary outcomes were changes in body weight, waist circumference, the Diabetes Distress Scale (DDS), quality of life (IWQOL-L), and hunger (VAS). Generalized linear effects models were used for statistical analysis. RESULTS Participants (n = 136) were 56.8 ± 0.8 y (Mean ± SEM), 36.9 ± 0.5 kg/m2, 80.2% female, 62.2% non-Hispanic white. Baseline HbA1c, weight, and total DDS score were 8.0 ± 0.09%, 101.10 ± 1.47 kg, and 2.35 ± 0.08, respectively. At week 24, HbA1c, body weight, and total DDS decreased by 0.75 ± 0.11%, 5.74 ± 0.50%, 0.33 ± 0.10 units, respectively (all p < 0.001). Also, at week 24, quality of life increased by 9.0 ± 1.2 units and hunger decreased by 14.3 ± 2.4 units, (both p < 0.0001). CONCLUSIONS The scalable, virtually delivered T2D-tailored weight management program had favorable and clinically meaningful effects on glycemic control, body weight, and psychosocial outcomes.
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Affiliation(s)
- John W Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | | | | | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Edmond P Wickham
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Autumn Lanoye
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Gary D Foster
- WW International, Inc., New York, NY, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle I Cardel
- WW International, Inc., New York, NY, USA
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL, USA
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17
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Puhl RM, Lessard LM, Foster GD, Cardel MI. Parent-child communication about weight: Priorities for parental education and support. Pediatr Obes 2023; 18:e13027. [PMID: 37005556 DOI: 10.1111/ijpo.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Approximately 2/3 of parents talk about body weight with their children, which can include negative comments that have adverse health implications for youth. OBJECTIVES To identify ways to improve supportive parent-child communication about weight, we assessed parent and youth perspectives of barriers to weight communication, preferences for educational resources and support, and whether perspectives differ across demographic groups and weight status. METHODS In Fall 2021, online surveys were completed by two independent, unrelated samples of parents (N = 1936) and youth (N = 2032). Participants were asked about their perceived barriers to talking about weight, and what kinds of information and support would be most useful to them in fostering supportive communication. RESULTS Parent and youth-reported barriers to weight communication included discomfort and lack of knowledge about weight, and views that weight does not need to be discussed. Most parents wanted guidance on how to navigate multiple weight-related topics with their children, including promoting positive body image and healthy behaviours, reducing weight criticism, focusing more on health and addressing weight-based bullying. Youth preferences for how their parents can be more supportive of their weight included avoiding weight-related criticism and pressures, increasing sensitivity and encouragement, and emphasizing healthy behaviours rather than weight. Few differences emerged based on sex and race/ethnicity, although several differences emerged for youth engaged in weight management. CONCLUSION Parent and youth perspectives indicate a need for education to help parents engage in supportive conversations about body weight. Findings can inform efforts to reduce barriers and increase supportive weight-related communication in families.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Leah M Lessard
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- WW International, Inc., New York, New York, USA
| | - Michelle I Cardel
- WW International, Inc., New York, New York, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
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Nanyiti S, Kabaalu R, Alicai T, Abidrabo P, Seal SE, Bouvaine S, Bailey AM, Foster GD. Detection of cassava brown streak ipomoviruses in aphids collected from cassava plants. Front Sustain Food Syst 2023. [DOI: 10.3389/fsufs.2023.1027842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Cassava is an important staple food in Africa and a major source of carbohydrates for 800 million people globally. However, cassava suffers severe yield losses caused by many factors including pests and diseases. A devastating disease of cassava is cassava brown streak disease (CBSD) caused by the cassava brown streak ipomoviruses (CBSIs) (family Potyviridae), Cassava brown streak virus (CBSV), and Ugandan cassava brown streak virus (UCBSV). Spread of CBSD is mainly through planting infected stem cuttings used for propagation. Transmission of CBSIs by the insect vector (Bemisia tabaci) has been reported. However, experimental transmission efficiencies of CBSIs are usually low. Recent research has showed the occurrence of a DAG motif associated with aphid transmission in other potyviruses, within the coat protein gene of CBSV. Consequently this study aimed to explore the possibility that besides whiteflies, aphids may transmit CBSIs. Cassava plants were assessed during a survey for occurrence of CBSD and aphids as potential alternative CBSIs vectors. We collected aphids from CBSD-symptomatic and symptomless cassava plants within farmers' fields in Uganda during April–July 2020. The aphids were analyzed for the presence of CBSIs by reverse transcriptase-polymerase chain reaction (RT-PCR) and to determine aphid species using mitochondrial cytochrome oxidase (mtCOI) barcoding. Unusual aphid infestation of cassava plants was observed at 35 locations in nine districts across Uganda and on 11 other plant species within or adjacent to cassava fields. This is the first report of aphids infesting cassava in Uganda. Molecular analysis of the aphid confirmed presence of three different aphid species in the surveyed cassava fields, namely, Aphis solanella, Aphis fabae mordvilkoi, and Rhopalosiphum sp. mtCOI nucleotide sequences for the aphids in which CBSIs were detected are deposited with Genbank under accession numbers OP223337-40. Both UCBSV and CBSV were detected by RT-PCR in aphids collected from cassava fields with CBSD-affected plants. The CBSIs were detected in 14 aphid samples collected from 19 CBSD-symptomatic cassava plants. These results suggest the ability of aphids to acquire CBSIs, but transmission experiments are required on their vector potential.
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Daniel-Weiner R, Cardel MI, Skarlinski M, Goscilo A, Anderson C, Foster GD. Enabling Informed Decision Making in the Absence of Detailed Nutrition Labels: A Model to Estimate the Added Sugar Content of Foods. Nutrients 2023; 15:nu15040803. [PMID: 36839162 PMCID: PMC9961734 DOI: 10.3390/nu15040803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Obesity and diabetes have emerged as an increasing threat to public health, and the consumption of added sugar can contribute to their development. Though nutritional content information can positively influence consumption behavior, added sugar is not currently required to be disclosed in all countries. However, a growing proportion of the world's population has access to mobile devices, which allow for the development of digital solutions to support health-related decisions and behaviors. To test whether advances in computational science can be leveraged to develop an accurate and scalable model to estimate the added sugar content of foods based on their nutrient profile, we collected comprehensive nutritional information, including information on added sugar content, for 69,769 foods. Eighty percent of this data was used to train a gradient boosted tree model to estimate added sugar content, while 20% of it was held out to assess the predictive accuracy of the model. The performance of the resulting model showed 93.25% explained variance per default portion size (84.32% per 100 kcal). The mean absolute error of the estimate was 0.84 g per default portion size (0.81 g per 100 kcal). This model can therefore be used to deliver accurate estimates of added sugar through digital devices in countries where the information is not disclosed on packaged foods, thus enabling consumers to be aware of the added sugar content of a wide variety of foods.
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Affiliation(s)
- Reka Daniel-Weiner
- WW International, Inc., New York, NY 10100, USA
- Correspondence: (R.D.-W.); (M.I.C.)
| | - Michelle I. Cardel
- WW International, Inc., New York, NY 10100, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL 32611, USA
- Correspondence: (R.D.-W.); (M.I.C.)
| | | | | | | | - Gary D. Foster
- WW International, Inc., New York, NY 10100, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Lawrence SE, Lessard LM, Puhl RM, Foster GD, Cardel MI. "Look beyond the weight and accept me": Adolescent perspectives on parental weight communication. Body Image 2023; 45:11-19. [PMID: 36731347 DOI: 10.1016/j.bodyim.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/09/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
Critical weight communication between parents and their adolescent children is prevalent and harmful. However, research on adolescent perspectives about parental weight communication is limited. The present mixed-methods study aimed to address this gap using inductive thematic analysis of 1743 adolescents' (Mage=14.61 years, SDage=2.48) preferences regarding parental weight communication in response to an open-ended prompt, and quantitative analyses to examine age, gender, race/ethnicity, and weight-related differences in subthemes. In their responses, adolescents articulated 1) whether and 2) how parental weight communication should-or should not-occur, and 3) what these conversations should entail. We identified 15 subthemes across these categories-the endorsement of which often varied by adolescents' demographic and anthropometric characteristics. For example, some adolescents (especially cisgender girls and transgender/gender diverse adolescents) preferred that their parents talk about weight less often (n = 184), while others (especially multiracial/ethnic or Hispanic/Latinx adolescents) hoped that, if parents were to discuss weight with them, they do so in a manner that was compassionate and respectful (n = 150). Across most subthemes, adolescents described adverse responses (e.g., feeling insecure, embarrassed, or hurt) when parents discussed their weight in non-preferred ways. Collectively, findings can inform interventions to promote more supportive health-focused communication in families.
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Affiliation(s)
- Samantha E Lawrence
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT, USA; Department of Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota - Twin Cities, Minneapolis, MN, USA.
| | - Leah M Lessard
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT, USA; Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Gary D Foster
- WW International, Inc., New York, NY, USA; Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle I Cardel
- WW International, Inc., New York, NY, USA; Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
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21
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Alberti F, Khairudin K, Davies JA, Sangmalee S, Willis CL, Foster GD, Bailey AM. Biosynthesis of pleuromutilin congeners using an Aspergillus oryzae expression platform. Chem Sci 2023; 14:3826-3833. [PMID: 37035691 PMCID: PMC10074412 DOI: 10.1039/d2sc06638f] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
Pleuromutilin is an antibiotic diterpenoid made by Clitopilus passeckerianus and related fungi, and it is the progenitor of a growing class of semi-synthetic antibiotics used in veterinary and human medicine....
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Affiliation(s)
- Fabrizio Alberti
- School of Biological Sciences, University of Bristol 24 Tyndall Avenue Bristol BS8 1TQ UK
| | - Khairunisa Khairudin
- School of Biological Sciences, University of Bristol 24 Tyndall Avenue Bristol BS8 1TQ UK
| | - Jonathan A Davies
- School of Chemistry, University of Bristol Cantock's Close Bristol BS8 1TS UK
| | - Suphattra Sangmalee
- School of Biological Sciences, University of Bristol 24 Tyndall Avenue Bristol BS8 1TQ UK
| | - Christine L Willis
- School of Chemistry, University of Bristol Cantock's Close Bristol BS8 1TS UK
| | - Gary D Foster
- School of Biological Sciences, University of Bristol 24 Tyndall Avenue Bristol BS8 1TQ UK
| | - Andy M Bailey
- School of Biological Sciences, University of Bristol 24 Tyndall Avenue Bristol BS8 1TQ UK
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22
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Hayes JF, Wing RR, Phelan S, Alarcon N, Cardel MI, Foster GD. Recovery from weight regain among long-term weight loss maintainers in WW. Obesity (Silver Spring) 2022; 30:2404-2413. [PMID: 36281635 PMCID: PMC9691556 DOI: 10.1002/oby.23573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/07/2022] [Accepted: 07/31/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study sought to understand the process and strategies to recover from regain among weight loss maintainers. METHODS Participants in WeightWatchers (WW; n = 2457) had lost ≥9 kg for ≥1 year and were grouped based on self-reported weight change after maximum loss: sustained maintenance ("Stable"), ups and downs ("Gain-Lose"), and regain ("Gain"). The groups were compared on weight control strategies, and the Gain-Lose and Gain groups reported on attempts to reverse weight regain. RESULTS Mean weight loss was 28.5 kg and duration of ≥9 kg loss was 3.5 years. During this time, 48% reported weight stability, and the remaining reported some regain (Gain-Lose, 29% or Gain, 23%). Among Gain and Gain-Lose, action to lose regained weight occurred after gaining >4 kg. Compared with Gain, Gain-Lose sustained reengagement efforts longer (16 vs. 10 weeks) and had better dietary choices (3.4 vs. 3.2), self-monitoring (2.9 vs. 2.7), and psychological coping (2.5 vs. 2.4) scores. Among Gain-Lose, the most successful (< 2.3 kg vs. >2.3 kg regain) initiated weight loss efforts after less regain (2.3 vs. 4.5 kg). CONCLUSIONS Reengaging with weight loss after regains may be most successful if focused on diet, self-monitoring, and psychological coping and initiated with less regain.
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Affiliation(s)
- Jacqueline F Hayes
- Warren Alpert Medical School at Brown University & The Miriam Hospital Weight Control & Diabetes Research Center, Providence, Rhode Island, USA
| | - Rena R Wing
- Warren Alpert Medical School at Brown University & The Miriam Hospital Weight Control & Diabetes Research Center, Providence, Rhode Island, USA
| | - Suzanne Phelan
- Department of Kinesiology & Public Health and Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Noemi Alarcon
- Department of Kinesiology & Public Health and Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Michelle I Cardel
- WW International, Inc., New York, New York, USA
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Gary D Foster
- WW International, Inc., New York, New York, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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23
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Puhl RM, Lessard LM, Foster GD, Cardel MI. Patient and Family Perspectives on Terms for Obesity. Pediatrics 2022; 150:190093. [PMID: 36404759 DOI: 10.1542/peds.2022-058204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Parent communication about body weight is a sensitive topic, but limited research has studied youth preferences for words used to talk about their weight with parents. We assessed perspectives of weight-based terminology in 2 racially/ethnically diverse samples of youth and parents. METHODS We collected online survey data from 2 panel survey samples between September and December 2021: youth aged 10 to 17 years (n = 2032) and parents of youth aged 10 to 17 years (n = 1936). Participants rated 27 different terms and phrases to describe body weight; parents reported on their usage of this terminology and youth reported their preferences for and emotional responses to terminology. Patterns were examined across sex, race/ethnicity, sexual orientation, and weight status. RESULTS Youth reported preferences for words such as "healthy weight" and dislike of terms such as "obese," "fat," and "large," which induced feelings of sadness, shame, and embarrassment. Differences in youth preferences and emotional reactions were present across sex, sexual orientation, race/ethnicity, and weight status. This included a general pattern of lower preference ratings among girls (versus boys) and sexual minority (versus heterosexual) youth, and stronger preferences for words such as "thick" or "curvy" among racial/ethnic minority, sexual minority, and higher-weight youth. Use of most weight terms was higher among fathers compared with mothers, and by Hispanic/Latinx parents compared with white and Black/African American parents. CONCLUSIONS Our findings underscore diversity of youth preferences and the need for individualized approaches that support effective parent and youth communication by using their preferred terms when discussing weight-related health.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut.,Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Leah M Lessard
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,WW International, Inc, New York, New York
| | - Michelle I Cardel
- WW International, Inc, New York, New York.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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24
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Puhl RM, Lessard LM, Pudney EV, Foster GD, Cardel MI. Motivations for engaging in or avoiding conversations about weight: Adolescent and parent perspectives. Pediatr Obes 2022; 17:e12962. [PMID: 36350198 DOI: 10.1111/ijpo.12962] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about parent and adolescent motivations for engaging in weight communication. OBJECTIVES To assess parent and adolescent motivations for engaging in, or avoiding, weight communication, and whether these reasons differed across sex, race/ethnicity, weight, and engagement in weight management. METHODS Independent samples of parents (N = 1936) and unrelated adolescents (N = 2032) completed questionnaires assessing their agreement with different reasons they engage in, or avoid, parent-adolescent weight communication, using 7-point Likert scales (strongly-disagree to strongly-agree). RESULTS Parents, irrespective of sex, race/ethnicity, and child's weight status, expressed stronger motivations for engaging in weight communication in order for their child to feel good about his/her weight and body size compared to being motivated because a health professional raised their child's weight as a concern. Adolescent motivations for weight communication with parents stemmed from health concerns and worry about their weight; avoidance stemmed from feeling embarrassed, upset, or not wanting to obsess about weight. Differences emerged across sex and race/ethnicity but were most pronounced by weight status and weight management. CONCLUSION Parents and adolescents have different motivations for engaging in or avoiding weight communication. Protecting adolescents' emotional wellbeing and body esteem are viewed as reasons for both engaging in or avoiding weight communication.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA.,Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Leah M Lessard
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | - Ellen V Pudney
- Department of Pediatrics, Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Gary D Foster
- WW International, Inc., New York, New York, USA.,Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle I Cardel
- WW International, Inc., New York, New York, USA.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
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25
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Cáceres NA, Yu Q, Lauzon M, Diniz MA, Tuckerman R, Carrillo A, Philipp M, Foster GD, Seitz AR, Salvy S. Supplementing a widely available weight loss program with gamified inhibitory control training: A randomized pilot study. Obes Sci Pract 2022; 8:775-783. [PMID: 36483117 PMCID: PMC9722449 DOI: 10.1002/osp4.617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Increasing evidence suggests that targeting self-regulatory processes may improve obesity treatment outcomes. Incorporating gamification principles in inhibitory control training may promote sustained training adherence and resulting benefits. This pilot study evaluated the preliminary efficacy of supplementing an evidence-based weight management program (WW) with sustained gamified inhibitory control training (PolyRules!) on change in Body Mass Index (BMI) among adults with overweight/obesity. Methods 30 adults with overweight/obesity (M age 49.9 ± 12.4, 86.7% female; 23.3% Hispanic, mean BMI 35.3 ± 6.3) were randomly assigned to receive WW with or without PolyRules! for 12 weeks. The primary outcome was change in BMI from baseline to post-intervention across study arms. Implementation and process indicators were captured to inform larger trials. Results Average change in BMI was -0.9 in the WW arm and -1.2 in the WW + PolyRules! arm (Cohen's d = 0.26). In the WW + PolyRules! arm, increased training was associated with greater decreases in BMI (r = -0.506, p = 0.0454). WW + PolyRules! participants completed an average of 60.4% sessions and reported positive experiences. There was no difference in frequency of food (d = -0.02) and weight tracking (d = -0.19) between arms. Conclusions Studies in larger samples should evaluate training-related effects on weight. Supplementing WW with gamified inhibitory training appears feasible, with no detrimental effect on engagement.
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Affiliation(s)
- Nenette A. Cáceres
- Cancer Research Center for Health EquityCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Qihan Yu
- Cancer Research Center for Health EquityCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Marie Lauzon
- Biostatistics and Bioinformatics Research CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Marcio A. Diniz
- Biostatistics and Bioinformatics Research CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Rebecca Tuckerman
- Department of PsychologyUniversity of CaliforniaRiversideCaliforniaUSA
| | | | | | - Gary D. Foster
- WW International, IncNew YorkNYUSA
- Center for Weight and Eating DisordersPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Aaron R. Seitz
- Department of PsychologyUniversity of CaliforniaRiversideCaliforniaUSA
- UCR Brain Game CenterRiversideCaliforniaUSA
| | - Sarah‐Jeanne Salvy
- Cancer Research Center for Health EquityCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
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26
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Tate DF, Lutes LD, Bryant M, Truesdale KP, Hatley KE, Griffiths Z, Tang TS, Padgett LD, Pinto AM, Stevens J, Foster GD. Efficacy of a Commercial Weight Management Program Compared With a Do-It-Yourself Approach: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2226561. [PMID: 35972742 PMCID: PMC9382439 DOI: 10.1001/jamanetworkopen.2022.26561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Given the prevalence of obesity, accessible and effective treatment options are needed to manage obesity and its comorbid conditions. Commercial weight management programs are a potential solution to the lack of available treatment, providing greater access at lower cost than clinic-based approaches, but few commercial programs have been rigorously evaluated. OBJECTIVE To compare the differences in weight change between individuals randomly assigned to a commercial weight management program and those randomly assigned to a do-it-yourself (DIY) approach. DESIGN, SETTING, AND PARTICIPANTS This 1-year, randomized clinical trial conducted in the United States, Canada, and United Kingdom between June 19, 2018, and November 30, 2019, enrolled 373 adults aged 18 to 75 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45. Assessors were blinded to treatment conditions. INTERVENTIONS A widely available commercial weight management program that included reduced requirements for dietary self-monitoring and recommendations for a variety of DIY approaches to weight loss. MAIN OUTCOMES AND MEASURES The primary outcomes were the difference in weight change between the 2 groups at 3 and 12 months. The a priori hypothesis was that the commercial program would result in greater weight loss than the DIY approach at 3 and 12 months. Analyses were performed on an intention-to-treat basis. RESULTS The study include 373 participants (272 women [72.9%]; mean [SD] BMI, 33.8 [5.2]; 77 [20.6%] aged 18-34 years, 74 [19.8%] aged 35-43 years, 82 [22.0%] aged 44-52 years, and 140 [37.5%] aged 53-75 years). At 12 months, retention rates were 88.8% (166 of 187) for the commercial weight management program group and 95.7% (178 of 186) for the DIY group. At 3 months, participants in the commercial program had a mean (SD) weight loss of -3.8 (4.1) kg vs -1.8 (3.7) kg among those in the DIY group. At 12 months, participants in the commercial program had a mean (SD) weight loss of -4.4 (7.3) kg vs -1.7 (7.3) kg among those in the DIY group. The mean difference between groups was -2.0 kg (97.5% CI, -2.9 to -1.1 kg) at 3 months (P < .001) and -2.6 kg (97.5% CI, -4.3 to -0.8 kg) at 12 months (P < .001). A greater percentage of participants in the commercial program group than participants in the DIY group achieved loss of 5% of body weight at both 3 months (40.7% [72 of 177] vs 18.6% [34 of 183]) and 12 months (42.8% [71 of 166] vs 24.7% [44 of 178]). CONCLUSIONS AND RELEVANCE Adults randomly assigned to a commercial weight management program with reduced requirements for dietary self-monitoring lost more weight and were more likely to achieve weight loss of 5% at 3 and 12 months than adults following a DIY approach. This study contributes data on the efficacy of commercial weight management programs and DIY weight management approaches. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03571893.
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Affiliation(s)
- Deborah F. Tate
- Department of Nutrition, University of North Carolina at Chapel Hill
- Department of Health Behavior, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Lesley D. Lutes
- Department of Psychology, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Maria Bryant
- Department of Health Sciences, University of York, York, United Kingdom
- The Hull York Medical School, University of York, York, United Kingdom
| | | | - Karen E. Hatley
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | | | - Tricia S. Tang
- Department of Medicine, University of British Columbia, Vancouver Campus, Vancouver, British Columbia, Canada
| | - Louise D. Padgett
- Department of Health Sciences, University of York, York, United Kingdom
| | - Angela M. Pinto
- Department of Psychology, Baruch College/City University of New York, New York
| | - June Stevens
- Department of Nutrition, University of North Carolina at Chapel Hill
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Gary D. Foster
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- WW, Maidenhead, Berkshire, UK
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27
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Cáceres NA, Yu Q, Capaldi J, Diniz MA, Raynor H, Foster GD, Seitz AR, Salvy SJ. Evaluating environmental and inhibitory control strategies to improve outcomes in a widely available weight loss program. Contemp Clin Trials 2022; 119:106844. [DOI: 10.1016/j.cct.2022.106844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/10/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
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Abstract
Since the initial detection, in 2007, of fungal ribosomally synthesised and post-translationally modified peptides (RiPPs), this group of natural products has undergone rapid expansion, with four separate classes now recognised: amatoxins/phallotoxins, borosins, dikaritins, and epichloëcyclins. Largely due to their historically anthropocentric employment in medicine and agriculture, novel fungal proteins and peptides are seldom investigated in relation to the fungus itself. Therefore, although the benefits these compounds confer to humans are often realised, their evolutionary advantage to the fungus, the reason for their continued production, is often obscure or ignored. This review sets out to summarise current knowledge on how these small peptide-derived products influence their producing species and surrounding biotic environment.
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Affiliation(s)
- R E Ford
- School of Biological Sciences, University of Bristol, Life Sciences Building, 28 Tyndall Ave, Bristol, BS8 1TQ, UK
| | - G D Foster
- School of Biological Sciences, University of Bristol, Life Sciences Building, 28 Tyndall Ave, Bristol, BS8 1TQ, UK
| | - A M Bailey
- School of Biological Sciences, University of Bristol, Life Sciences Building, 28 Tyndall Ave, Bristol, BS8 1TQ, UK.
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29
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Bailey-Davis L, Pinto AM, Hanna DJ, Rethorst CD, Still CD, Foster GD. Qualitative inquiry with primary care providers and specialists about adult weight management care and referrals. Transl Behav Med 2022; 12:576-584. [PMID: 35195267 PMCID: PMC9132206 DOI: 10.1093/tbm/ibac006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Obesity is a highly prevalent disease and providers are expected to offer or refer patients for weight management yet increasingly fewer clinical visits address obesity. Challenges to offering care are known but less is known about referrals and how specialists who treat obesity-related comorbidities address care and referrals. This study explored perceptions of primary care providers (PCPs) and specialty providers regarding care and referrals for weight management, specifically referrals to programs in the community setting. A qualitative design was used to interview 33 PCPs (mean age 54 years) and 31 specialists (cardiology, gynecology, endocrinology, and orthopedics [mean age 62 years]) in the USA during 2019. Each interview was conducted by telephone, audio-recorded, and transcribed verbatim. Inductive analysis was used and followed the constant comparative method. Four themes emerged from the data including (a) Clinical guidelines and provider discretion influence obesity care; (b) Facilitators and barriers to discussing weight and small step strategies; (c) Informal referrals are made for weight management in community settings; and (d) Opportunities and challenges for integrating clinical and community services for weight management. Facilitating referrals to effective programs, ideally with a feedback loop could coordinate care and enhance accountability, but education, compliance, and cost issues need addressed. Care may be offered but not be well-aligned with clinical guidelines. Knowledge gaps regarding community programs' offerings and efficacy were evident. Referrals could be systematically promoted, facilitated, and tracked to advance weight management objectives.
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Affiliation(s)
- Lisa Bailey-Davis
- Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
- Obesity Research Institute, Geisinger, Danville, PA 17822, USA
| | | | - David J Hanna
- Obesity Research Institute, Geisinger, Danville, PA 17822, USA
| | | | | | - Gary D Foster
- WW International, Inc., New York, NY 10010, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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30
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Puhl RM, Lessard LM, Foster GD, Cardel MI. A Comprehensive Examination of the Nature, Frequency, and Context of Parental Weight Communication: Perspectives of Parents and Adolescents. Nutrients 2022; 14:nu14081562. [PMID: 35458124 PMCID: PMC9032323 DOI: 10.3390/nu14081562] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 02/01/2023] Open
Abstract
Research suggests that many parents make comments about their child’s weight, which is associated with negative adolescent health outcomes. Gaps in this literature include an underrepresentation of fathers, limited knowledge regarding positive versus negative parental weight comments and differences across race/ethnicity, and adolescent preferences for parental weight communication. The present study addressed these research gaps through a comprehensive investigation of two diverse samples of U.S. parents (n = 1936) and adolescents (n = 2032), who completed questionnaires about their experiences and perspectives of parental weight communication. Positive weight comments from parents were more frequent than negative comments, though both were commonly reported across sex, race/ethnicity, and weight status. In general, boys, fathers, Latino/a parents and adolescents, and adolescents with a high BMI and/or engaged in weight management reported more frequent parental weight-talk. Parent–adolescent weight communication occurred both in-person and digitally, and across daily life contexts. Although the majority of parents communicated positive messages of body diversity and respect, 44% and 63% of adolescents said they never want their mothers and fathers, respectively, to talk about their weight. Adolescents were offered circumstances that would increase their comfort level in having these conversations. Findings have implications for health professionals working with families to promote supportive health communication at home.
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Affiliation(s)
- Rebecca M. Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT 06269, USA
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT 06103, USA;
- Correspondence:
| | - Leah M. Lessard
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT 06103, USA;
| | - Gary D. Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
- WW International, Inc., New York, NY 10010, USA;
| | - Michelle I. Cardel
- WW International, Inc., New York, NY 10010, USA;
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32611, USA
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31
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Phelan S, Roake J, Alarcon N, Ng SM, Glanz H, Cardel MI, Foster GD. In their own words: Topic analysis of the motivations and strategies of over 6,000 long-term weight-loss maintainers. Obesity (Silver Spring) 2022; 30:751-761. [PMID: 35137557 PMCID: PMC9305441 DOI: 10.1002/oby.23372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed to identify major themes of a large cohort experiencing long-term weight-loss maintenance who answered open-ended questions about weight-loss triggers, current motivations, strategies, and experiences. METHODS Machine learning and topic modeling were used to analyze responses to six open-ended questions among 6,139 WW International, Inc., (formerly Weight Watchers) members with weight-loss maintenance; inclusion criteria included ≥9.1-kg loss with weight-loss maintenance for ≥1 year. RESULTS Participants (mean age = 53.6 years; 94.3% White; mean BMI = 27.8 kg/m2 ) had lost 24.5 kg and maintained the loss for 3.4 years. Descriptions of factors triggering weight loss coalesced into five topics: medical status, appearance, mobility, social prompts, and change needed. Factors currently motivating weight-loss maintenance yielded two topics: looking back at experiences at higher weight and health/appearance concerns. Advice for others to succeed in weight-loss maintenance coalesced on two recommendations: perseverance in the face of setbacks and consistency in tracking. Rewards for weight management included improved confidence, pain, mobility, fitness, body image, medical status, and affect. Two thematic negative consequences were clothing costs and sagging skin. CONCLUSIONS Future weight-maintenance research should include more diverse populations and investigate weight-loss maintenance as a journey with highs and lows, perseverance in the face of setbacks, sustained tracking, and making changes in medical status more salient during the weight-maintenance journey.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology and Public HealthCenter for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - James Roake
- Department of Kinesiology and Public HealthCenter for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Noemi Alarcon
- Department of Kinesiology and Public HealthCenter for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Sarah M. Ng
- Department of Kinesiology and Public HealthCenter for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Hunter Glanz
- Department of StatisticsCenter for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Michelle I. Cardel
- WW International, Inc.New YorkNew YorkUSA
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Gary D. Foster
- WW International, Inc.New YorkNew YorkUSA
- Center for Weight and Eating DisordersPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Young J, Phelan S, Alarcon N, Roake J, Rethorst CD, Foster GD. Factors associated with food choice among long-term weight loss maintainers. J Hum Nutr Diet 2021; 35:924-933. [PMID: 34970802 PMCID: PMC9544241 DOI: 10.1111/jhn.12977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 01/11/2023]
Abstract
Background The present study aimed to examine motivations for food choice among long‐term weight loss maintainers (WLM) in a widely used commercial weight management program. Methods A cross‐sectional study was employed where determinants of food choice were measured in the USA using validated scales: Food Choice Questionnaire, Consideration of Future Consequences, and Eating in the Absence of Hunger. Participants were 3806 WLM following a commercial weight management program (WW International, Inc.) who had maintained a weight loss ≥ 9.1 kg (mean 24.7 kg) for 3.3 years and had a body mass index (BMI) of 27.6 kg m2. A control group of weight stable individuals with obesity (controls; n = 519) had a BMI of 38.9 kg m2 and a weight change < 2.3 kg over the previous 5 years. Results WLM vs. controls made food decisions more based on health (18.9 vs. 16.3; ηp2 = 0.052) and weight control (9.9 vs. 7.5; ηp2 = 0.16) and less based on price (8.4 vs. 9.1; ηp2 = 0.10). WLM also scored higher than controls with respect to considering future consequences of behaviours (44.3 vs. 38.4; ηp2 = 0.060) and reported less external eating in the absence of hunger (7.1 vs. 7.5; ηp2 = 0.058). Standard canonical coefficients indicated that making food choices based on weight (0.717) with less value placed on price (−0.33) and greater consideration of future consequences (0.262) contributed independently and most (overall r = 0.593; p = 0.0001) to discriminating WLM from controls. Conclusions In a widely used commercial weight management program, successful WLM reported food decisions based more on weight and less on price and considered future consequences of current behaviours. Long‐term weight loss maintainers consume a diet that is low in calories and micronutrient rich, although the diverse factors that govern these food choices remain unclear. The present study examined diverse factors associated with food choice among weight loss maintainers in a widely used commercial weight management program (WW International, Inc.) compared to weight stable individuals with obesity (“controls”). Weight loss maintainers more than controls made food decisions based on health and weight control and less based on price. Both groups scored similarly in the role of convenience, mood, sensory appeal, natural content, familiarity and ethical concerns. Weight loss maintainers were overall more likely to consider future consequences. In a widely used commercial weight management program (WW International, Inc.), successful weight loss maintainers reported food decisions based more on weight and health and less on price. They also considered future consequences of current behaviours.
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Affiliation(s)
- Jacob Young
- Department of Kinesiology & Public Health, the Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Suzanne Phelan
- Department of Kinesiology & Public Health, the Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Noemi Alarcon
- Department of Kinesiology & Public Health, the Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - James Roake
- Department of Kinesiology & Public Health, the Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | | | - Gary D Foster
- WW International, Inc., New York, New York, USA.,Perelman School of Medicine, Center for Weight and Eating Disorders, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Luan D, Foster GD, Fisher JO, Weeks HM, Polonsky HM, Davey A, Sherman S, Abel ML, Bauer KW. Breakfast in the Classroom Initiative Does Not Improve Attendance or Standardized Test Scores among Urban Students: A Cluster Randomized Trial. J Acad Nutr Diet 2021; 122:1168-1173.e2. [PMID: 34923177 DOI: 10.1016/j.jand.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Breakfast in the Classroom (BIC), a common approach to implementing the federal School Breakfast Program, is advocated as a method to improve students' academic performance. However, the impacts of BIC on academic outcomes are unclear. OBJECTIVE To examine the effect of a BIC initiative which provided free, universal BIC on attendance and standardized test performance over 2.5 years, versus free universal breakfast served in the cafeteria before school, among students in an urban school district serving a low-income population. DESIGN Secondary analysis of data from a cluster randomized controlled trial conducted between 2013 and 2016; sixteen kindergarten through 8th grade public schools in Philadelphia, Pennsylvania were enrolled and randomized to condition. Baseline data for 1,362 4th through 6th grade students were provided by the school district. Midpoint data were collected after 1.5 years and endpoint data after 2.5 years. PARTICIPANTS/SETTING Schools were eligible if ≥50% of students qualified for free/reduced-priced meals, did not offer BIC, and received programming as part of the USDA's Supplemental Nutrition Assistance Program. Parents consented for their children to participate. INTERVENTION Intervention schools provided BIC and breakfast-related nutrition promotion activities. Control schools provided breakfast in the cafeteria before the school day. MAIN OUTCOME MEASURES Student attendance and standardized exam scores. STATISTICAL ANALYSES PERFORMED Weighted generalized estimating equations were used to evaluate differences in outcomes between conditions at midpoint and endpoint. RESULTS The BIC initiative did not impact attendance (Beta (SE) = 0.004 (0.06), P = 0.94) or standardized reading exam scores (Beta (SE) = 0.02 (0.06), P = 0.79) after 2.5 years. Students in BIC initiative schools had lower standardized math exam scores than those in control schools although this difference was small (Beta (SE) = -0.20 (0.07), P = 0.005). CONCLUSIONS BIC did not improve academic outcomes among students attending low-income, urban schools.
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Affiliation(s)
- Danny Luan
- Graduate student at the University of Michigan School of Public Health, Ann Arbor, MI at the time of this research. Mr. Luan is currently a medical student at Weill Cornell Medicine, New York, NY
| | - Gary D Foster
- WW International, New York NY and Adjunct Professor, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
| | - Jennifer O Fisher
- Department of Social & Behavioral Sciences, College of Public Health, Temple University, Philadelphia PA
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor MI
| | - Heather M Polonsky
- Study coordinator Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia PA at the time of this research. Ms. Polonsky is currently Associate Director of Evaluation, FoodCorps, Portland OR
| | - Adam Davey
- College of Health Sciences and Department of Behavioral Health and Nutrition, University of Delaware, Newark DE
| | | | - Michelle L Abel
- School Breakfast Policy Manager at The Food Trust, Philadelphia PA at the time of this research. Ms. Abel is currently a Program Manager at Children's Hospital of Philadelphia, Philadelphia PA
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor MI.
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Naseeb M, Bruneau ML, Milliron BJ, Sukumar D, Foster GD, Smith SA, Volpe SL. Changes in Dietary Magnesium Intake and Risk of Type 2 Diabetes Mellitus in Middle School Students: Using Data from the HEALTHY Study. J Nutr 2021; 151:3442-3449. [PMID: 34313771 PMCID: PMC8921608 DOI: 10.1093/jn/nxab272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/11/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The HEALTHY Study was a multicomponent school-based intervention, designed to prevent type 2 diabetes mellitus (T2DM) in middle-school students. OBJECTIVES We examined whether the difference in dietary magnesium intake, BMI percentile, and plasma glucose and insulin concentrations from 6th to 8th grade were related in the intervention schools and in the control schools that participated in the HEALTHY Study. METHODS A total of 2181 ethnically diverse students, from 11.3 to 13.7 y of age, with completed dietary records, BMI percentile, and plasma glucose and insulin concentrations at 6th and 8th grades were included. Dietary magnesium intake was self-reported using the Block Kids FFQ. A hierarchical multiple regression model was used to determine whether the differences in dietary magnesium intake, BMI percentile, and plasma glucose and insulin concentrations from 6th to 8th grades were related, while adjusting for dietary calcium intake and total energy intake. RESULTS The difference in dietary magnesium intake was significantly related to changes in BMI percentile from 6th to 8th grade in intervention and in control schools [intervention: β: -0.07; 95% CI: -0.58, -0.02; P = 0.03; R2 (regression coefficient effect size): 0.14; 95% CI for R2: 0.10, 0.17; control: β: -0.08; 95% CI: -0.63, -0.09; P = 0.01; R2: 0.12; 95% CI for R2: 0.08, 0.15]. The difference in dietary magnesium intake was not related to plasma glucose and insulin concentrations in intervention and in control schools. CONCLUSIONS We conclude that a multicomponent intervention was associated with reduced risk of T2DM, and that this association may be modulated, in part, by magnesium. The differences in dietary magnesium intake from 6th to 8th grade were negatively related to changes in BMI percentile among middle-school students.
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Affiliation(s)
- Manal Naseeb
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Michael L Bruneau
- Department of Health Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Deeptha Sukumar
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | | | - Sinclair A Smith
- Department of Health Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Stella L Volpe
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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Puhl RM, Lessard LM, Pearl RL, Grupski A, Foster GD. Policies to address weight discrimination and bullying: Perspectives of adults engaged in weight management from six nations. Obesity (Silver Spring) 2021; 29:1787-1798. [PMID: 34612007 PMCID: PMC8571064 DOI: 10.1002/oby.23275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Across the world, it remains legal to discriminate against people because of their weight. Although US studies demonstrate public support for laws to prohibit weight discrimination, multinational research is scarce. The present study conducted a multinational comparison of support for legislative measures to address weight discrimination and bullying across six countries. METHODS Participants were adults (n = 13,996) enrolled in an international weight-management program and residing in Australia, Canada, France, Germany, the UK, and the US. Participants completed identical online surveys that assessed support for antidiscrimination laws and policies to address weight bullying, demographic characteristics, and personal experiences of weight stigma. RESULTS Across countries, support was high for laws (90%) and policies (92%) to address weight-based bullying, whereas greater between-country variation emerged in support for legislation to address weight-based discrimination in employment (61%, 79%), as a human rights issue (57%), and through existing disability protections (47%). Findings highlight few and inconsistent links between policy support and sociodemographic correlates or experienced or internalized weight stigma. CONCLUSIONS Support for policies to address weight stigma is present among people engaged in weight management across Westernized countries; findings offer an informative comparison point for future cross-country research and can inform policy discourse to address weight discrimination and bullying.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Leah M Lessard
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- WW International, Inc, New York, New York, USA
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Pearl RL, Puhl RM, Himmelstein MS, Pinto AM, Foster GD. Weight Stigma and Weight-Related Health: Associations of Self-Report Measures Among Adults in Weight Management. Ann Behav Med 2021; 54:904-914. [PMID: 32333673 DOI: 10.1093/abm/kaaa026] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Weight stigma impairs health. Few studies have disentangled the associations of experienced versus internalized stigma with weight-related outcomes. PURPOSE To examine weight and health variables associated with weight stigma experiences and internalization in the largest-to-date sample of adults in weight management. METHODS WW (formerly Weight Watchers) members (N = 18,769, 94.6% female, 91.1% white) completed an online survey from 2017 to 2018. Participants reported whether they had experienced weight stigma and, if so, the onset, past-year frequency and distress, and interpersonal sources of stigma. Participants completed the Modified Weight Bias Internalization Scale (WBIS-M) and self-reported: past-year weight and lifetime weight cycles; current self-monitoring behaviors; eating self-efficacy; physical activity; perceived stress; eating to cope; body image; and mental and physical health-related quality-of-life (HRQOL). Participants reported their demographic characteristics, including height and weight to compute body mass index. RESULTS In logistic and linear regression analyses (controlling for participant characteristics), WBIS-M scores were negatively associated with weight loss, self-monitoring, eating self-efficacy, body image, and mental HRQOL and positively associated with weight gain, weight cycling, perceived stress, and eating to cope (p < .001). Experiencing weight stigma was associated with greater weight loss and less weight gain, although associations with other variables had small effect sizes (absolute β values < 0.10). WBIS-M scores remained significantly associated with all variables when including stigma onset, frequency/distress, and sources. CONCLUSIONS Internalized, but not experienced, weight stigma was consistently associated with adverse weight and health factors. Developing and testing interventions targeting internalized stigma in the context of weight management should be a research priority.
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Affiliation(s)
- Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca M Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Mary S Himmelstein
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.,Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Angela M Pinto
- Science Department, WW (formerly Weight Watchers) International, Inc., New York, NY, USA.,Department of Psychology, Baruch College, City University of New York, New York, NY, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Science Department, WW (formerly Weight Watchers) International, Inc., New York, NY, USA
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Bullard T, Medcalf A, Rethorst C, Foster GD. Impact of the COVID-19 pandemic on initial weight loss in a digital weight management program: A natural experiment. Obesity (Silver Spring) 2021; 29:1434-1438. [PMID: 34009723 PMCID: PMC8456790 DOI: 10.1002/oby.23233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/13/2021] [Accepted: 05/15/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on initial weight loss during a digital weight management program. METHODS Participants (n = 866,192; BMI 33.6 [SD 7.4] kg/m2 ) who joined a digital weight management program (WW) in the first 30 weeks of 2020 (COVID-19 cohort) were compared with participants (n = 624,043; BMI 33.1 [SD 7.2] kg/m2 ) who joined the same program during the same time period in 2019 (control cohort). Weight change (percentage) and self-monitoring over the first 4 weeks of enrollment were compared between the cohorts. Significance was defined as meeting the criteria for a small effect (d ≥ 0.2). RESULTS Over the 30-week enrollment period, the COVID-19 cohort experienced significantly less weight loss than the control cohort but only for 7 weeks of enrollments. The COVID-19 cohort also had fewer days of food tracking but only for 3 weeks of enrollments. There were no differences in the self-monitoring of weight and activity at any time between the two cohorts. CONCLUSIONS Over a 30-week enrollment period, COVID-19 had negative effects on both weight loss and food self-monitoring, but the effects were short-lived. Those participating in evidence-based weight management programs can expect similar levels of initial weight loss as those experienced before the pandemic.
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Affiliation(s)
| | | | | | - Gary D. Foster
- WW InternationalNew YorkNew YorkUSA
- Center for Weight and Eating Disorders ProgramPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Puhl RM, Lessard LM, Pearl RL, Himmelstein MS, Foster GD. International comparisons of weight stigma: addressing a void in the field. Int J Obes (Lond) 2021; 45:1976-1985. [PMID: 34059785 DOI: 10.1038/s41366-021-00860-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Despite substantial evidence documenting weight stigma toward people with higher body weight, international comparative studies are lacking in this field. The few studies that have compared weight stigma across different countries focus on explicit weight-biased attitudes rather than people's experiences of weight stigma. The present study conducted a multinational systematic comparison of weight stigma in six countries to assess experiences and interpersonal sources of weight stigma. SUBJECTS/METHODS Adults (N = 13,996) enrolled in WW International (formerly Weight Watchers), residing in Australia, Canada, France, Germany, the UK, and the US completed identical online anonymous surveys in the dominant language for their country. Surveys assessed their history of experiencing weight stigma, the onset of stigmatizing experiences and associated distress from stigma in different time periods, and interpersonal sources of weight stigma. RESULTS More than half of participants (55.6-61.3%) across countries reported experiencing weight stigma. Participants with higher BMI were significantly more likely to report weight-stigmatizing experiences than individuals with lower BMI. In all countries, weight stigma experiences were most frequent in childhood and adolescence, with associated distress highest during these time periods. Participants in Germany reported a higher frequency of weight stigma across their whole life, but lower distress associated with stigmatizing experiences, compared to participants in the other five countries. High percentages of participants in each country experienced weight stigma from family members (76.0-87.8%), classmates (72.0-80.9%), doctors (62.6-73.5%), co-workers (54.1-61.7%), and friends (48.8-66.2%). CONCLUSIONS Weight stigma is prevalent for adults actively engaged in weight management across different Western countries. There were more similarities than differences in the nature, frequency, and interpersonal sources of people's experiences of weight stigma across the six countries in this study. Findings underscore the need for multinational initiatives to address weight stigma and interventions to support individuals engaged in weight management who experience weight mistreatment.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, USA. .,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA.
| | - Leah M Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Mary S Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,WW International, Inc., New York, NY, USA
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Hales SB, Schulte EM, Turner TF, Malcolm R, Wojtanowski AC, Rethorst C, Pinto AM, Foster GD, O'Neil PM. Pilot evaluation of a personalized commercial program on weight loss, health outcomes, and quality of life. Transl Behav Med 2021; 11:2091-2098. [PMID: 34479369 DOI: 10.1093/tbm/ibab110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
WW is a validated behavioral weight management program that encourages healthy habits. WW developed a method of personalizing the SmartPoints® budget depending on dietary and lifestyle preferences, and participants were placed into one of three plans as a pilot evaluation of this new program. In this 6-month, single-arm pilot study, participants attended weekly workshops and used an app to monitor eating and physical activity. Baseline and 6-month assessments included weight, waist circumference, blood pressure, energy intake, cravings, happiness, health-related quality of life, hunger, and fullness. Of 145 adults assessed at baseline, 126 (87%) provided follow-up data. Pre-post changes showed significant reductions in body weight (7.39% ± 5.93%), calories consumed (24.79% ± 32.35%) and significant improvements in cravings, happiness, all SF-36 scales and hunger but not in fullness. Greater % weight loss was related to greater improvements in happiness (r = .38, p < .001), general health perceptions (r = .29, p = .001), and health change (r = .31, p = .001), and greater reduction in role limitations due to personal or emotional problems (r = .24, p = .01). Greater % reduction in caloric intake was associated with greater reductions in cravings (r = .23, p = .01), as well as with greater improvements in happiness (r = .23, p = .01), physical functioning (r = .23, p = .01), and general health perceptions (r = .23, p = .01). Participants in this modified program achieved significant weight loss, regardless of dietary plan, as well as improvements in a variety of other physical and psychological constructs. Those who achieved greater reductions in weight also reported greater improvements in cravings, happiness and some quality of life measures.
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Affiliation(s)
- Sarah B Hales
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Erica M Schulte
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tonya F Turner
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Robert Malcolm
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Angela M Pinto
- Department of Psychology, Baruch College, New York, NY, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,WW International, Inc., New York, NY, USA
| | - Patrick M O'Neil
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Lessard LM, Puhl RM, Himmelstein MS, Pearl RL, Foster GD. Eating and Exercise-Related Correlates of Weight Stigma: A Multinational Investigation. Obesity (Silver Spring) 2021; 29:966-970. [PMID: 34029444 DOI: 10.1002/oby.23168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/11/2021] [Accepted: 03/03/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Weight stigma is prevalent across the world. However, little is known about whether and how the harmful health consequences of weight stigma may vary across countries. The current study examined the association between experiences of weight stigma and multiple eating and exercise-related indicators among a large, multinational sample of adults. METHODS Adults enrolled in an international weight management program residing in Australia, Canada, France, Germany, the United Kingdom, and the United States completed identical Web-based surveys in the dominant language for their country. Participants (N = 13,996) reported on their personal experiences of weight stigma and health, including eating behaviors, attitudes toward exercise, and perceived stress. RESULTS More than half of all participants in each country reported experiencing weight stigma. Participants who had experienced weight stigma reported engaging in more eating to cope, gym avoidance, and self-monitoring behaviors, as well as higher levels of stress and reduced eating self-efficacy. These associations were documented over and above sociodemographic characteristics and BMI and did not vary across countries. CONCLUSIONS Study findings document uniform health-related correlates of weight stigma within a multinational context and underscore the need for global initiatives to curtail weight stigma in order to support population health.
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Affiliation(s)
- Leah M Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Mary S Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gary D Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- WW International, Inc, New York, New York, USA
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Roake J, Phelan S, Alarcon N, Keadle SK, Rethorst CD, Foster GD. Sitting Time, Type, and Context Among Long-Term Weight-Loss Maintainers. Obesity (Silver Spring) 2021; 29:1067-1073. [PMID: 34029443 DOI: 10.1002/oby.23148] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to investigate sitting time, the home sedentary environment, and physical activity among weight-loss maintainers in WW (formerly Weight Watchers). METHODS Participants were 4,305 weight-loss maintainers who had maintained ≥9.1 kg of weight loss (24.7 kg on average) for 3.3 years and had an average current BMI of 27.6 kg/m2 . A control group of weight-stable individuals with obesity (n = 619) had an average BMI of 38.9 kg/m2 . The Multicontext Sitting Time Questionnaire and Paffenbarger physical activity questionnaire were administered. RESULTS Weight-loss maintainers versus controls spent 3 hours less per day sitting during the week (10.9 vs. 13.9; η p 2 = 0.039; P = 0.0001) and weekends (9.7 vs. 12.6; η p 2 = 0.038). Weight-loss maintainers versus controls spent 1 hour less per day in non-work-related sitting using a computer or video games during the week (1.4 vs. 2.3; η p 2 = 0.03; P = 0.0001) and weekends (1.5 vs. 2.5; η p 2 = 0.03; P = 0.0001). Weight-loss maintainers versus controls had similar numbers of sedentary-promoting devices (15.8 vs. 14.8) and expended significantly more calories per week in physical activity (1,835 vs. 785; η p 2 = 0.036; P = 0.0001). CONCLUSIONS Weight-loss maintainers reported less time sitting than weight-stable individuals with obesity. Future research should test the efficacy of targeting sitting time to help promote long-term weight-loss maintenance.
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Affiliation(s)
- James Roake
- Department of Kinesiology & Public Health & The Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Suzanne Phelan
- Department of Kinesiology & Public Health & The Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Noemi Alarcon
- Department of Kinesiology & Public Health & The Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Sarah K Keadle
- Department of Kinesiology & Public Health & The Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | | | - Gary D Foster
- WW International, Inc., New York, New York, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Puhl RM, Lessard LM, Himmelstein MS, Foster GD. The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries. PLoS One 2021; 16:e0251566. [PMID: 34061867 PMCID: PMC8168902 DOI: 10.1371/journal.pone.0251566] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES Considerable evidence from U.S. studies suggests that weight stigma is consequential for patient-provider interactions and healthcare for people with high body weight. Despite international calls for efforts to reduce weight stigma in the medical community, cross-country research is lacking in this field. This study provides the first multinational investigation of associations between weight stigma and healthcare experiences across six Western countries. METHODS Participants were 13,996 adults residing in Australia, Canada, France, Germany, the UK, and the US who were actively enrolled in an internationally available behavioral weight management program. Participants completed identical online surveys in the dominant language for their country that assessed experienced weight stigma, internalized weight bias, and healthcare behaviors and experiences including perceived quality of care, avoidance or delay of seeking care, experiences with providers, and perceived weight stigma from doctors. RESULTS Among participants who reported a history of weight stigma (56-61%), two-thirds of participants in each country reported experiencing weight stigma from doctors. Across all six countries, after accounting for demographics, BMI, and experienced stigma, participants with higher internalized weight bias reported greater healthcare avoidance, increased perceived judgment from doctors due to body weight, lower frequency of obtaining routine checkups, less frequent listening and respect from providers, and lower quality of healthcare. Additionally, experienced weight stigma (from any source) was indirectly associated with poorer healthcare experiences through weight bias internalization, consistently across the six countries. CONCLUSIONS Weight stigma in healthcare is prevalent among adults actively engaged in weight management across different Western countries, and internalized weight bias has negative implications for healthcare even after controlling for BMI. The similar findings across all six countries underscore the negative consequences of weight stigma on healthcare behaviors and experiences, and emphasize the need for collective international efforts to address this problem.
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Affiliation(s)
- Rebecca M. Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, Connecticut, United States of America
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, United States of America
| | - Leah M. Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, United States of America
| | - Mary S. Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, Ohio, United States of America
| | - Gary D. Foster
- WW, New York, New York, United States of America
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Al-Salihi SAA, Bull ID, Al-Salhi R, Gates PJ, Salih KSM, Bailey AM, Foster GD. Further Biochemical Profiling of Hypholoma fasciculare Metabolome Reveals Its Chemogenetic Diversity. Front Bioeng Biotechnol 2021; 9:567384. [PMID: 34109161 PMCID: PMC8181146 DOI: 10.3389/fbioe.2021.567384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 04/01/2021] [Indexed: 11/30/2022] Open
Abstract
Natural products with novel chemistry are urgently needed to battle the continued increase in microbial drug resistance. Mushroom-forming fungi are underutilized as a source of novel antibiotics in the literature due to their challenging culture preparation and genetic intractability. However, modern fungal molecular and synthetic biology tools have renewed interest in exploring mushroom fungi for novel therapeutic agents. The aims of this study were to investigate the secondary metabolites of nine basidiomycetes, screen their biological and chemical properties, and then investigate the genetic pathways associated with their production. Of the nine fungi selected, Hypholoma fasciculare was revealed to be a highly active antagonistic species, with antimicrobial activity against three different microorganisms: Bacillus subtilis, Escherichia coli, and Saccharomyces cerevisiae. Genomic comparisons and chromatographic studies were employed to characterize more than 15 biosynthetic gene clusters and resulted in the identification of 3,5-dichloromethoxy benzoic acid as a potential antibacterial compound. The biosynthetic gene cluster for this product is also predicted. This study reinforces the potential of mushroom-forming fungi as an underexplored reservoir of bioactive natural products. Access to genomic data, and chemical-based frameworks, will assist the development and application of novel molecules with applications in both the pharmaceutical and agrochemical industries.
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Affiliation(s)
| | - Ian D. Bull
- School of Chemistry, University of Bristol, Bristol, United Kingdom
| | - Raghad Al-Salhi
- Chemistry Department, University of Mustansiriyah, Baghdad, Iraq
| | - Paul J. Gates
- School of Chemistry, University of Bristol, Bristol, United Kingdom
| | | | - Andy M. Bailey
- School of Biological Sciences, University of Bristol, Bristol, United Kingdom
| | - Gary D. Foster
- School of Biological Sciences, University of Bristol, Bristol, United Kingdom
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de Mattos-Shipley KMJ, Foster GD, Bailey AM. Cprp-An Unusual, Repetitive Protein Which Impacts Pleuromutilin Biosynthesis in the Basidiomycete Clitopilus passeckerianus. Front Fungal Biol 2021; 2:655323. [PMID: 37744150 PMCID: PMC10512284 DOI: 10.3389/ffunb.2021.655323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/04/2021] [Indexed: 09/26/2023]
Abstract
Interrogation of an EST database for Clitopilus passeckerianus identified a putative homolog to the unusual stress response gene from yeast; ddr48, as being upregulated under pleuromutilin production conditions. Silencing of this gene, named cprp, produced a population of transformants which demonstrated significantly reduced pleuromutilin production. Attempts to complement a Saccharomyces cerevisiae ddr48 mutant strain (strain Y16748) with cprp were hampered by the lack of a clearly identifiable mutant phenotype, but interestingly, overexpression of either ddr48 or cprp in S. cerevisiae Y16748 led to a conspicuous and comparable reduction in growth rate. This observation, combined with the known role of DDR48 proteins from a range of fungal species in nutrient starvation and stress responses, raises the possibility that this family of proteins plays a role in triggering oligotrophic growth. Localization studies via the production of a Cprp:GFP fusion protein in C. passeckerianus showed clear localization adjacent to the hyphal septa and, to a lesser extent, cell walls, which is consistent with the identification of DDR48 as a cell wall-associated protein in various yeast species. To our knowledge this is the first study demonstrating that a DDR48-like protein plays a role in the regulation of a secondary metabolite, and represents the first DDR48-like protein from a basidiomycete. Potential homologs can be identified across much of the Dikarya, suggesting that this unusual protein may play a central role in regulating both primary and secondary metabolism in fungi.
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Affiliation(s)
| | | | - Andy M. Bailey
- School of Biological Sciences, University of Bristol, Bristol, United Kingdom
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James AM, Seal SE, Bailey AM, Foster GD. Viral inosine triphosphatase: A mysterious enzyme with typical activity, but an atypical function. Mol Plant Pathol 2021; 22:382-389. [PMID: 33471956 PMCID: PMC7865087 DOI: 10.1111/mpp.13021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 05/03/2023]
Abstract
Plant viruses typically have highly condensed genomes, yet the plant-pathogenic viruses Cassava brown streak virus, Ugandan cassava brown streak virus, and Euphorbia ringspot virus are unusual in encoding an enzyme not yet found in any other virus, the "house-cleaning" enzyme inosine triphosphatase. Inosine triphosphatases (ITPases) are highly conserved enzymes that occur in all kingdoms of life and perform a house-cleaning function by hydrolysing the noncanonical nucleotide inosine triphosphate to inosine monophosphate. The ITPases encoded by cassava brown streak virus and Ugandan cassava brown streak virus have been characterized biochemically and are shown to have typical ITPase activity. However, their biological role in virus infection has yet to be elucidated. Here we review what is known of viral-encoded ITPases and speculate on potential roles in infection with the aim of generating a greater understanding of cassava brown streak viruses, a group of the world's most devastating viruses.
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Affiliation(s)
- Amy M. James
- School of Biological SciencesLife Sciences BuildingUniversity of BristolBristolUK
| | - Susan E. Seal
- Natural Resources Institute, Chatham MaritimeGillinghamUK
| | - Andy M. Bailey
- School of Biological SciencesLife Sciences BuildingUniversity of BristolBristolUK
| | - Gary D. Foster
- School of Biological SciencesLife Sciences BuildingUniversity of BristolBristolUK
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Pearl RL, Puhl RM, Lessard LM, Himmelstein MS, Foster GD. Prevalence and correlates of weight bias internalization in weight management: A multinational study. SSM Popul Health 2021; 13:100755. [PMID: 33718581 PMCID: PMC7920853 DOI: 10.1016/j.ssmph.2021.100755] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/08/2021] [Accepted: 02/07/2021] [Indexed: 12/24/2022] Open
Abstract
Weight bias internalization (WBI) is an understudied form of internalized stigma, particularly among treatment-seeking adults with overweight/obesity. The current study surveyed 13,996 adults currently engaged in weight management in the first multinational study of WBI. From May to July 2020, participants in six Western countries completed the Modified Weight Bias Internalization Scale (WBIS-M) and measures of weight change, health behaviors, psychosocial well-being, and health-related quality of life (HRQOL). Participants were majority white, female, middle-aged, and categorized as having overweight or obesity based on body mass index. Results showed higher mean WBIS-M scores among participants in the UK, Australia, and France than in Germany, the US, and Canada. Across all countries, and controlling for participant characteristics and experiences of weight stigma, WBIS-M scores were associated with greater weight gain in the past year. Participants with higher WBIS-M scores also reported poorer mental and physical HRQOL, less eating and physical activity self-efficacy, greater engagement in eating as a coping strategy, more avoidance of going to the gym, poorer body image, and greater perceived stress. Few interaction effects were found between experiences and internalization of weight stigma. Overall, the current findings support WBI as a robust correlate of adverse weight-related health indices across six Western countries. Prospective and experimental studies are needed to determine directionality and causality in the relationship between WBI and poor health outcomes. Differences in weight bias internalization (WBI) were found between six Western countries. WBI was associated with weight gain in the past year across countries. WBI was associated with adverse weight-related health indices across countries. Associations with weight and health were stronger for WBI than weight stigma experiences.
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Affiliation(s)
- Rebecca L. Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Corresponding author. Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, FL, 32610, USA.
| | - Rebecca M. Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Leah M. Lessard
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | | | - Gary D. Foster
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- WW International, Inc., New York, NY, USA
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47
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Agrawal S, Wojtanowski AC, Tringali L, Foster GD, Finkelstein EA. Financial implications of New York City's weight management initiative. PLoS One 2021; 16:e0246621. [PMID: 33571249 PMCID: PMC7877753 DOI: 10.1371/journal.pone.0246621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To estimate potential annual savings in medical expenditures from a subsidized weight management program from the NYC Government perspective. Design Longitudinal observational study. Setting Employees of New York City (NYC) government and enrolled dependents. Sample 14,946 participants with overweight and obesity. Intervention WW (formerly Weight Watchers®) ‘Workshop’ and ‘Digital’ programs. Measures Participation rate, enrollment duration, weight change, and predicted gross and net total and per capita medical expenditure savings and return on investment (ROI). Analysis Participation rate, enrollment duration, weight change, and program costs are based on direct observation. Predicted savings are simulated based on published data relating weight loss to medical expenditure reductions. Results In total, 47% of participating employees and 50% of participating dependents lost weight during the enrollment period. Mean (median) enrollment duration for employees was 7.1 months (7.0) and for dependents was 6.9 months (6.0). Mean (median) weight losses for the employees in ‘Workshops’ and ‘Digital’ was 6.6 lbs (2.80) and 6.3 lbs (0.0). For dependents, weight losses were 7.4 lbs (3.59) and 11.6 lbs (2.0). Per capita and total predicted net savings to NYC Government from employees was estimated to be $120 and $1,486,102 for an ROI of 143%. Including dependents, predicted net savings increases to $1,963,431 for an ROI of 189%. Over 80% of savings came from participants in the Obese III category. Conclusion An evidence-based weight management program has the potential to generate a positive ROI for employers. Future studies should validate these estimates using actual data and more rigorous designs.
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Affiliation(s)
- Sagun Agrawal
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Laura Tringali
- WW International (formerly Weight Watchers), New York, NY, United States of America
| | - Gary D. Foster
- WW International (formerly Weight Watchers), New York, NY, United States of America
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States of America
| | - Eric A. Finkelstein
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- * E-mail:
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48
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Kuna ST, Reboussin DM, Strotmeyer ES, Millman RP, Zammit G, Walkup MP, Wadden TA, Wing RR, Pi-Sunyer FX, Spira AP, Foster GD. Effects of Weight Loss on Obstructive Sleep Apnea Severity. Ten-Year Results of the Sleep AHEAD Study. Am J Respir Crit Care Med 2021; 203:221-229. [PMID: 32721163 DOI: 10.1164/rccm.201912-2511oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Rationale: Weight loss is recommended to treat obstructive sleep apnea (OSA).Objectives: To determine whether the initial benefit of intensive lifestyle intervention (ILI) for weight loss on OSA severity is maintained at 10 years.Methods: Ten-year follow-up polysomnograms of 134 of 264 adults in Sleep AHEAD (Action for Health in Diabetes) with overweight/obesity, type 2 diabetes mellitus, and OSA were randomized to ILI for weight loss or diabetes support and education (DSE).Measurements and Main Results: Change in apnea-hypopnea index (AHI) was measured. Mean ± SE weight losses of ILI participants of 10.7 ± 0.7, 7.4 ± 0.7, 5.1 ± 0.7, and 7.1 ± 0.8 kg at 1, 2, 4, and 10 years, respectively, were significantly greater than the 1-kg weight loss at 1, 2, and 4 years and 3.5 ± 0.8 kg weight loss at 10 years for the DSE group (P values ≤ 0.0001). AHI was lower with ILI than DSE by 9.7, 8.0, and 7.9 events/h at 1, 2, and 4 years, respectively (P values ≤ 0.0004), and 4.0 events/h at 10 years (P = 0.109). Change in AHI over time was related to amount of weight loss, baseline AHI, visit year (P values < 0.0001), and intervention independent of weight change (P = 0.01). OSA remission at 10 years was more common with ILI (34.4%) than DSE (22.2%).Conclusions: Participants with OSA and type 2 diabetes mellitus receiving ILI for weight loss had reduced OSA severity at 10 years. No difference in OSA severity was present between ILI and DSE groups at 10 years. Improvement in OSA severity over the 10-year period with ILI was related to change in body weight, baseline AHI, and intervention independent of weight change.
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Affiliation(s)
- Samuel T Kuna
- University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | - Gary D Foster
- Temple University, Philadelphia, Pennsylvania; and.,WW (formerly Weight Watchers), New York, New York
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Naseeb M, Milliron BJ, Bruneau ML, Sukumar D, Foster GD, Smith SA, Volpe SL. Dietary magnesium intake in relation to body mass index and glycemic indices in middle school students from the HEALTHY Study. Nutr Health 2021; 27:211-219. [PMID: 33530870 DOI: 10.1177/0260106020982345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Data on dietary magnesium intake on the risk of type 2 diabetes mellitus (T2DM) among children and adolescents is limited. AIM We examined whether dietary magnesium intake was related to body mass index (BMI) percentile, and glycemic indices at baseline and at end of the HEALTHY Study for both intervention and control schools. The HEALTHY Study was a multi-component, school-based intervention, to prevent T2DM in children and adolescents from 6th to 8th grades. METHODS A secondary data analyses of 2181 ethnically diverse students with completed dietary records, BMI percentile, and plasma insulin and glucose concentrations at baseline (6th grade) and end of study (8th grade) were included from the HEALTHY Study. Dietary magnesium intake was self-reported using the Block Kids Food Frequency Questionnaire. A hierarchical multiple regression model was used to determine the relationships between dietary magnesium intake, BMI percentile, and glycemic indices at baseline and end of the HEALTHY Study, adjusting for magnesium intake from supplements, total energy intake, and fitness level. RESULTS Dietary magnesium intake was related to BMI percentile at baseline and at end of the HEATHY Study (β = -0.05, 95% CI = -0.02 to 0, p = 0.04; β = -0.06, 95% CI = -0.02 to -0.003, p = 0.004); R 2 [regression coefficient effect size] = 0.03; R 2 = 0.06). Dietary magnesium intake was not related to plasma insulin and glucose concentrations at baseline and end of the HEALTHY Study. CONCLUSION Dietary magnesium intake was inversely related to BMI percentile among middle school students from the HEALTHY Study. Research is required to evaluate the dose-response relationship between fruit and vegetable consumption (good sources of magnesium) and risk of T2DM in children and adolescents. This relationship also needs to be explored among different BMI categories.
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Affiliation(s)
- Manal Naseeb
- Clinical Nutrition Department, 6527Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences, 6527Drexel University, Philadelphia, PA, USA
| | - Michael L Bruneau
- Department of Health Sciences, 6527Drexel University, Philadelphia, PA, USA
| | - Deeptha Sukumar
- Department of Nutrition Sciences, 6527Drexel University, Philadelphia, PA, USA
| | | | - Sinclair A Smith
- Department of Health Sciences, 6527Drexel University, Philadelphia, PA, USA
| | - Stella L Volpe
- 1757Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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Rees HJ, Bashir N, Drakulic J, Cromey MG, Bailey AM, Foster GD. Identification of native endophytic Trichoderma spp. for investigation of in vitro antagonism towards Armillaria mellea using synthetic- and plant-based substrates. J Appl Microbiol 2020; 131:392-403. [PMID: 33219581 DOI: 10.1111/jam.14938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
AIMS To isolate endophytic Trichoderma species and investigate the potential for biological control of the root rot pathogen Armillaria mellea. METHODS AND RESULTS In all, 40 Trichoderma isolates were obtained from a range of host plants and identities were confirmed by ITS, rpb2 and tef1 sequence. When tested in dual culture assays for antagonism against A. mellea, Trichoderma isolates overgrew the A. mellea colonies within four days and by eight days 38 Trichoderma isolates significantly reduced A. mellea colony size. Armillaria mellea was unable to be recovered from five of eight co-cultivations tested, suggesting Trichoderma had killed the A. mellea in these cases. Pre-colonized hazel disks were used to determine what happens in a more heterogeneous situation with A. mellea and a refined set of eight Trichoderma isolates. Similar to plate-based assays, Trichoderma quickly covered A. mellea stopping any further growth and two Trichoderma isolates were able to eradicate A. mellea. CONCLUSIONS Of the Trichoderma spp. tested, endophytic isolates of Trichoderma virens and T. hamatum offered the greatest antagonism towards A. mellea. Using pre-colonized hazel disks was of great importance for this work to demonstrate the fungal interactions in plant material. SIGNIFICANCE AND IMPACT OF THE STUDY Controlling Armillaria root rot is difficult with chemical treatments, thus an environmentally benign and cost-effective alternative is required. This study highlights the prospect of biological control as an effective, environmentally friendly alternative to chemicals.
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Affiliation(s)
- H J Rees
- School of Biological Sciences, University of Bristol, Bristol, UK.,Royal Horticultural Society, Department of Plant Health, RHS Wisley, Woking, Surrey, UK
| | - N Bashir
- Royal Horticultural Society, Department of Plant Health, RHS Wisley, Woking, Surrey, UK
| | - J Drakulic
- Royal Horticultural Society, Department of Plant Health, RHS Wisley, Woking, Surrey, UK
| | - M G Cromey
- Royal Horticultural Society, Department of Plant Health, RHS Wisley, Woking, Surrey, UK
| | - A M Bailey
- School of Biological Sciences, University of Bristol, Bristol, UK
| | - G D Foster
- School of Biological Sciences, University of Bristol, Bristol, UK
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