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Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, Coday M, Crow RS, Curtis JM, Egan CM, Espeland MA, Evans M, Foreyt JP, Ghazarian S, Gregg EW, Harrison B, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Kitabchi AE, Knowler WC, Lewis CE, Maschak-Carey BJ, Montez MG, Murillo A, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Reboussin D, Regensteiner JG, Rickman AD, Ryan DH, Safford M, Wadden TA, Wagenknecht LE, West DS, Williamson DF, Yanovski SZ. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013; 369:145-54. [PMID: 23796131 PMCID: PMC3791615 DOI: 10.1056/nejmoa1212914] [Citation(s) in RCA: 1928] [Impact Index Per Article: 160.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. METHODS In 16 study centers in the United States, we randomly assigned 5145 overweight or obese patients with type 2 diabetes to participate in an intensive lifestyle intervention that promoted weight loss through decreased caloric intake and increased physical activity (intervention group) or to receive diabetes support and education (control group). The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for angina during a maximum follow-up of 13.5 years. RESULTS The trial was stopped early on the basis of a futility analysis when the median follow-up was 9.6 years. Weight loss was greater in the intervention group than in the control group throughout the study (8.6% vs. 0.7% at 1 year; 6.0% vs. 3.5% at study end). The intensive lifestyle intervention also produced greater reductions in glycated hemoglobin and greater initial improvements in fitness and all cardiovascular risk factors, except for low-density-lipoprotein cholesterol levels. The primary outcome occurred in 403 patients in the intervention group and in 418 in the control group (1.83 and 1.92 events per 100 person-years, respectively; hazard ratio in the intervention group, 0.95; 95% confidence interval, 0.83 to 1.09; P=0.51). CONCLUSIONS An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the National Institutes of Health and others; Look AHEAD ClinicalTrials.gov number, NCT00017953.).
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Multicenter Study |
12 |
1928 |
2
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Fishman D, Faulds G, Jeffery R, Mohamed-Ali V, Yudkin JS, Humphries S, Woo P. The effect of novel polymorphisms in the interleukin-6 (IL-6) gene on IL-6 transcription and plasma IL-6 levels, and an association with systemic-onset juvenile chronic arthritis. J Clin Invest 1998; 102:1369-76. [PMID: 9769329 PMCID: PMC508984 DOI: 10.1172/jci2629] [Citation(s) in RCA: 1650] [Impact Index Per Article: 61.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
During active disease, patients with systemic-onset juvenile chronic arthritis (S-JCA) demonstrate a rise and fall in serum interleukin-6 (IL-6) that parallels the classic quotidian fever. To investigate the possibility that this cytokine profile results from a difference in the control of IL-6 expression, we examined the 5' flanking region of the IL-6 gene for polymorphisms. A G/C polymorphism was detected at position -174. In a group of 383 healthy men and women from a general practice in North London, the frequency of the C allele was 0.403 (95% confidence interval 0.37-0.44). In comparison, 92 patients with S-JCA had a different overall genotype frequency, especially those with onset of disease at < 5 yr of age. This was mainly due to the statistically significant lower frequency of the CC genotype in this subgroup. When comparing constructs of the 5' flanking region (-550-+61 bp) in a luciferase reporter vector transiently transfected into HeLa cells, the -174C construct showed 0.624+/-0.15-fold lower expression than the -174G construct. After stimulation with LPS or IL-1, expression from the -174C construct did not significantly change after 24 h, whereas expression from the -174G construct increased by 2.35+/-0.10- and 3.60+/-0.26-fold, respectively, compared with the unstimulated level. Plasma levels of IL-6 were also measured in 102 of the healthy subjects, and the C allele was found to be associated with significantly lower levels of plasma IL-6. These results suggest that there is a genetically determined difference in the degree of the IL-6 response to stressful stimuli between individuals. The reduced frequency of the potentially protective CC genotype in young S-JCA patients may contribute to its pathogenesis. Similarly the individual's IL-6 genotype may be highly relevant in other conditions where IL-6 has been implicated, such as atherosclerosis.
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27 |
1650 |
3
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Pi-Sunyer X, Blackburn G, Brancati FL, Bray GA, Bright R, Clark JM, Curtis JM, Espeland MA, Foreyt JP, Graves K, Haffner SM, Harrison B, Hill JO, Horton ES, Jakicic J, Jeffery RW, Johnson KC, Kahn S, Kelley DE, Kitabchi AE, Knowler WC, Lewis CE, Maschak-Carey BJ, Montgomery B, Nathan DM, Patricio J, Peters A, Redmon JB, Reeves RS, Ryan DH, Safford M, Van Dorsten B, Wadden TA, Wagenknecht L, Wesche-Thobaben J, Wing RR, Yanovski SZ. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care 2007; 30:1374-83. [PMID: 17363746 PMCID: PMC2665929 DOI: 10.2337/dc07-0048] [Citation(s) in RCA: 1030] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The effectiveness of intentional weight loss in reducing cardiovascular disease (CVD) events in type 2 diabetes is unknown. This report describes 1-year changes in CVD risk factors in a trial designed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events. RESEARCH DESIGN AND METHODS This study consisted of a multicentered, randomized, controlled trial of 5,145 individuals with type 2 diabetes, aged 45-74 years, with BMI >25 kg/m2 (>27 kg/m2 if taking insulin). An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education (DSE) condition. RESULTS Participants assigned to ILI lost an average 8.6% of their initial weight vs. 0.7% in DSE group (P < 0.001). Mean fitness increased in ILI by 20.9 vs. 5.8% in DSE (P < 0.001). A greater proportion of ILI participants had reductions in diabetes, hypertension, and lipid-lowering medicines. Mean A1C dropped from 7.3 to 6.6% in ILI (P < 0.001) vs. from 7.3 to 7.2% in DSE. Systolic and diastolic pressure, triglycerides, HDL cholesterol, and urine albumin-to-creatinine ratio improved significantly more in ILI than DSE participants (all P < 0.01). CONCLUSIONS At 1 year, ILI resulted in clinically significant weight loss in people with type 2 diabetes. This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE. Continued intervention and follow-up will determine whether these changes are maintained and will reduce CVD risk.
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Multicenter Study |
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1030 |
4
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Abstract
Obesity has increased dramatically over the past two decades and currently about 50% of US adults and 25% of US children are overweight. The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity. This chapter reviews what is known about environmental influences on physical activity and eating behaviors. Recent trends in food supply, eating out, physical activity, and inactivity are reviewed, as are the effects of advertising, promotion, and pricing on eating and physical activity. Public health interventions, opportunities, and potential strategies to combat the obesity epidemic by promoting an environment that supports healthy eating and physical activity are discussed.
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Review |
24 |
800 |
5
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Alison MR, Poulsom R, Jeffery R, Dhillon AP, Quaglia A, Jacob J, Novelli M, Prentice G, Williamson J, Wright NA. Hepatocytes from non-hepatic adult stem cells. Nature 2000; 406:257. [PMID: 10917519 DOI: 10.1038/35018642] [Citation(s) in RCA: 737] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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25 |
737 |
6
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Jeffery RW, Drewnowski A, Epstein LH, Stunkard AJ, Wilson GT, Wing RR, Hill DR. Long-term maintenance of weight loss: current status. Health Psychol 2000; 19:5-16. [PMID: 10709944 DOI: 10.1037/0278-6133.19.suppl1.5] [Citation(s) in RCA: 713] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intervention strategies for promoting long-term weight loss are examined empirically and conceptually. Weight control research over the last 20 years has dramatically improved short-term treatment efficacy but has been less successful in improving long-term success. Interventions in preadolescent children show greater long-term efficacy than in adults. Extending treatment length and putting more emphasis on energy expenditure have modestly improved long-term weight loss in adults. Fresh ideas are needed to push the field forward. Suggested research priorities are patient retention, natural history, assessment of intake and expenditure, obesity phenotypes, adolescence at a critical period, behavioral preference-reinforcement value, physical activity and social support, better linkage of new conceptual models to behavioral treatments, and the interface between pharmacological and behavioral methods.
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Review |
25 |
713 |
7
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Ikramuddin S, Korner J, Lee WJ, Connett JE, Inabnet WB, Billington CJ, Thomas AJ, Leslie DB, Chong K, Jeffery RW, Ahmed L, Vella A, Chuang LM, Bessler M, Sarr MG, Swain JM, Laqua P, Jensen MD, Bantle JP. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA 2013; 309:2240-9. [PMID: 23736733 PMCID: PMC3954742 DOI: 10.1001/jama.2013.5835] [Citation(s) in RCA: 540] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Controlling glycemia, blood pressure, and cholesterol is important for patients with diabetes. How best to achieve this goal is unknown. OBJECTIVE To compare Roux-en-Y gastric bypass with lifestyle and intensive medical management to achieve control of comorbid risk factors. DESIGN, SETTING, AND PARTICIPANTS A 12-month, 2-group unblinded randomized trial at 4 teaching hospitals in the United States and Taiwan involving 120 participants who had a hemoglobin A1c (HbA1c) level of 8.0% or higher, body mass index (BMI) between 30.0 and 39.9, C peptide level of more than 1.0 ng/mL, and type 2 diabetes for at least 6 months. The study began in April 2008. INTERVENTIONS Lifestyle-intensive medical management intervention and Roux-en-Y gastric bypass surgery. Medications for hyperglycemia, hypertension, and dyslipidemia were prescribed according to protocol and surgical techniques that were standardized. MAIN OUTCOMES AND MEASURES Composite goal of HbA1c less than 7.0%, low-density lipoprotein cholesterol less than 100 mg/dL, and systolic blood pressure less than 130 mm Hg. RESULTS All 120 patients received the intensive lifestyle-medical management protocol and 60 were randomly assigned to undergo Roux-en-Y gastric bypass. After 12-months, 28 participants (49%; 95% CI, 36%-63%) in the gastric bypass group and 11 (19%; 95% CI, 10%-32%) in the lifestyle-medical management group achieved the primary end points (odds ratio [OR], 4.8; 95% CI, 1.9-11.7). Participants in the gastric bypass group required 3.0 fewer medications (mean, 1.7 vs 4.8; 95% CI for the difference, 2.3-3.6) and lost 26.1% vs 7.9% of their initial body weigh compared with the lifestyle-medical management group (difference, 17.5%; 95% CI, 14.2%-20.7%). Regression analyses indicated that achieving the composite end point was primarily attributable to weight loss. There were 22 serious adverse events in the gastric bypass group, including 1 cardiovascular event, and 15 in the lifestyle-medical management group. There were 4 perioperative complications and 6 late postoperative complications. The gastric bypass group experienced more nutritional deficiency than the lifestyle-medical management group. CONCLUSIONS AND RELEVANCE In mild to moderately obese patients with type 2 diabetes, adding gastric bypass surgery to lifestyle and medical management was associated with a greater likelihood of achieving the composite goal. Potential benefits of adding gastric bypass surgery to the best lifestyle and medical management strategies of diabetes must be weighed against the risk of serious adverse events. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00641251.
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Multicenter Study |
12 |
540 |
8
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Gregg E, Jakicic J, Blackburn G, Bloomquist P, Bray G, Clark J, Coday M, Curtis J, Egan C, Evans M, Foreyt J, Foster G, Hazuda H, Hill J, Horton E, Hubbard V, Jeffery R, Johnson K, Kitabchi A, Knowler W, Kriska A, Lang W, Lewis C, Montez M, Nathan D, Neiberg R, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Redmon B, Regensteiner J, Rejeski J, Ribisl P, Safford M, Stewart K, Trence D, Wadden T, Wing R, Yanovski S. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol 2016; 4:913-921. [PMID: 27595918 PMCID: PMC5094846 DOI: 10.1016/s2213-8587(16)30162-0] [Citation(s) in RCA: 475] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Findings from the Look AHEAD trial showed no significant reductions in the primary outcome of cardiovascular disease incidence in adults with type 2 diabetes randomly assigned to an intensive lifestyle intervention for weight loss compared with those randomly assigned to diabetes support and education (control). We examined whether the incidence of cardiovascular disease in Look AHEAD varied by changes in weight or fitness. METHODS Look AHEAD was a randomised clinical trial done at 16 clinical sites in the USA, recruiting patients from Aug 22, 2001, to April 30, 2004. In the trial, 5145 overweight or obese adults aged 45-76 years with type 2 diabetes were assigned (1:1) to an intensive lifestyle intervention or diabetes support and education. In this observational, post-hoc analysis, we examined the association of magnitude of weight loss and fitness change over the first year with incidence of cardiovascular disease. The primary outcome of the trial and of this analysis was a composite of death from cardiovascular causes, non-fatal acute myocardial infarction, non-fatal stroke, or admission to hospital for angina. The secondary outcome included the same indices plus coronary artery bypass grafting, carotid endartectomy, percutaneous coronary intervention, hospitalisation for congestive heart failure, peripheral vascular disease, or total mortality. We adjusted analyses for baseline differences in weight or fitness, demographic characteristics, and risk factors for cardiovascular disease. The Look AHEAD trial is registered with ClinicalTrials.gov, number NCT00017953. FINDINGS For the analyses related to weight change, we excluded 311 ineligible participants, leaving a population of 4834; for the analyses related to fitness change, we excluded 739 participants, leaving a population of 4406. In analyses of the full cohort (ie, combining both study groups), over a median 10·2 years of follow-up (IQR 9·5-10·7), individuals who lost at least 10% of their bodyweight in the first year of the study had a 21% lower risk of the primary outcome (adjusted hazard ratio [HR] 0·79, 95% CI 0·64-0·98; p=0·034) and a 24% reduced risk of the secondary outcome (adjusted HR 0·76, 95% CI 0·63-0·91; p=0·003) compared with individuals with stable weight or weight gain. Achieving an increase of at least 2 metabolic equivalents in fitness change was associated with a significant reduction in the secondary outcome (adjusted HR 0·77, 95% CI 0·61-0·96; p=0·023) but not the primary outcome (adjusted HR 0·78, 0·60-1·03; p=0·079). In analyses treating the control group as the reference group, participants in the intensive lifestyle intervention group who lost at least 10% of their bodyweight had a 20% lower risk of the primary outcome (adjusted HR 0·80, 95% CI 0·65-0·99; p=0·039), and a 21% lower risk of the secondary outcome (adjusted HR 0·79, 95% CI 0·66-0·95; p=0·011); however, change in fitness was not significantly associated with a change in the primary outcome. INTERPRETATION The results of this post-hoc analysis of Look AHEAD suggest an association between the magnitude of weight loss and incidence of cardiovascular disease in people with type 2 diabetes. These findings suggest a need to continue to refine approaches to identify individuals who are most likely to benefit from lifestyle interventions and to develop strategies to improve the magnitude of sustained weight loss with lifestyle interventions. FUNDING US National Institute of Diabetes and Digestive and Kidney Diseases.
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Randomized Controlled Trial |
9 |
475 |
9
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Poulsom R, Forbes SJ, Hodivala-Dilke K, Ryan E, Wyles S, Navaratnarasah S, Jeffery R, Hunt T, Alison M, Cook T, Pusey C, Wright NA. Bone marrow contributes to renal parenchymal turnover and regeneration. J Pathol 2001; 195:229-35. [PMID: 11592103 DOI: 10.1002/path.976] [Citation(s) in RCA: 433] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In order to establish whether extra-renal cells contribute to the turnover and repair of renal tissues, this study examined kidneys of female mice that had received a male bone marrow transplant and kidney biopsies from male patients who had received kidney transplants from female donors. By using in situ hybridization to detect Y-chromosomes it could be demonstrated that circulating stem cells frequently engraft into the kidney and differentiate into renal parenchymal cells. In the human renal grafts it was confirmed that some of the recipient-derived cells within the kidney exhibited a tubular epithelial phenotype, by combining in situ hybridization with immunostaining for the epithelial markers CAM 5.2 and the lectin Ulex europaeus. Female mouse recipients of male bone marrow grafts showed co-localization of Y-chromosomes and tubular epithelial markers Ricinus communis and Lens culinaris, and a specific cytochrome P450 enzyme (CYP1A2) indicating an appropriate functional capability of clustered newly formed marrow-derived tubular epithelial cells. Y-chromosome-containing cells were observed within glomeruli, with morphology and location appropriate for podocytes. Within the murine kidney, these Y-chromosome-positive cells were negative for the mouse macrophage marker F4/80 antigen and leukocyte common antigen, but were vimentin-positive. The presence of bone marrow-derived cells was noted in both histologically normal mouse kidneys and in human transplanted kidneys suffering damage from a variety of causes. These data indicate that bone marrow cells contribute to both normal turnover of renal epithelia and regeneration after damage, and it is suggested that this could be exploited therapeutically.
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24 |
433 |
10
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French SA, Harnack L, Jeffery RW. Fast food restaurant use among women in the Pound of Prevention study: dietary, behavioral and demographic correlates. Int J Obes (Lond) 2000; 24:1353-9. [PMID: 11093299 DOI: 10.1038/sj.ijo.0801429] [Citation(s) in RCA: 383] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 891 adult women. DESIGN A survey was administered at baseline and 3 y later as part of a randomized, prospective intervention trial on weight gain prevention. SUBJECTS Women (n = 891) aged 20-45 y who enrolled in the Pound of Prevention study. MEASUREMENTS Frequency of fast food restaurant use, dietary intake, demographic and behavioral measures were self-reported. Dietary intake was measured using the 60-item Block Food Frequency Questionnaire. Body weight and height were directly measured. RESULTS Twenty-one percent of the sample reported eating > or = 3 fast food meals per week. Frequency of fast food restaurant use was associated with higher total energy intake, higher percentage fat energy, more frequent consumption of hamburgers, French fries and soft drinks, and less frequent consumption of fiber and fruit. Frequency of fast food restaurant use was higher among younger women, those with lower income, non-White ethnicity, greater body weight, lower dietary restraint, fewer low-fat eating behaviors, and greater television viewing. Over 3 y, increases in frequency of fast food restaurant use were associated with increases in body weight, total energy intake, percentage fat intake, intake of hamburgers, French fries and soft drinks, and with decreases in physical activity, dietary restraint and low-fat eating behaviors. Intake of several other foods, including fruits and vegetables, did not differ by frequency of fast food restaurant use. CONCLUSION Frequency of fast food restaurant use is associated with higher energy and fat intake and greater body weight, and could be an important risk factor for excess weight gain in the population.
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Clinical Trial |
25 |
383 |
11
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Ng DM, Jeffery RW. Relationships Between Perceived Stress and Health Behaviors in a Sample of Working Adults. Health Psychol 2003; 22:638-42. [PMID: 14640862 DOI: 10.1037/0278-6133.22.6.638] [Citation(s) in RCA: 376] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The study examined associations between perceived stress and fat intake, exercise, alcohol consumption, and smoking behaviors. Data were from surveys of 12,110 individuals in 26 worksites participating in the SUCCESS project (D. J. Hennrikus, R. W. Jeffery, & H. A. Lando, 1995), a study of smoking cessation interventions. Linear regression analyses examined cross-sectional associations between stress level and health behaviors. Analyses were stratified by gender and controlled for demographics. High stress for both men and women was associated with a higher fat diet, less frequent exercise, cigarette smoking, recent increases in smoking, less self-efficacy to quit smoking, and less self-efficacy to not smoke when stressed. Stress was not associated with alcohol intake. Findings suggest that the association between stress and disease may be moderated in part by unhealthy behaviors.
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22 |
376 |
12
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Wing RR, Jeffery RW. Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. J Consult Clin Psychol 1999; 67:132-8. [PMID: 10028217 DOI: 10.1037/0022-006x.67.1.132] [Citation(s) in RCA: 312] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To determine the benefits of social support for weight loss and maintenance, this study recruited participants (N = 166) either alone or with 3 friends or family members and then randomly assigned them to a standard behavioral treatment (SBT) or SBT with social support strategies. Participants recruited with friends had greater weight losses at the end of the 4-month treatment and at Month 10 follow-up. Both recruitment strategy and the social support manipulation affected treatment completion and weight-loss maintenance. In those recruited alone and given SBT, 76% completed treatment and 24% maintained their weight loss in full from Months 4 to 10. Among those recruited with friends and given SBT plus social support, 95% completed treatment and 66% maintained their weight loss in full.
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Clinical Trial |
26 |
312 |
13
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Jeffery RW, French SA. Epidemic obesity in the United States: are fast foods and television viewing contributing? Am J Public Health 1998; 88:277-80. [PMID: 9491022 PMCID: PMC1508201 DOI: 10.2105/ajph.88.2.277] [Citation(s) in RCA: 312] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined the association between TV viewing, fast food eating, and body mass index. METHODS Associations between hours of TV viewing, frequency of eating at fast food restaurants, body mass index, and behaviors were assessed cross sectionally and longitudinally over 1 year in 1059 men and women. RESULTS Fast food meals and TV viewing hours were positively associated with energy intake and body mass index in women but not in men. TV viewing predicted weight gain in high-income women. CONCLUSIONS Secular increases in fast food availability and access to televised entertainment may contribute to increasing obesity rates in the United States.
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research-article |
27 |
312 |
14
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Sherwood NE, Jeffery RW. The behavioral determinants of exercise: implications for physical activity interventions. Annu Rev Nutr 2001; 20:21-44. [PMID: 10940325 DOI: 10.1146/annurev.nutr.20.1.21] [Citation(s) in RCA: 297] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In light of the well-documented health benefits of physical activity and the fact that the majority of adult men and women are inactive, promoting regular physical activity is a public health priority. This chapter reviews current research findings regarding the determinants of exercise behavior. It also discusses the implications of this knowledge for individual and public health recommendations and intervention strategies for promoting physical activity. The discussion is predicated on the belief that physical activity is a complex, dynamic process. During their lives, individuals typically move through various phases of exercise participation that are determined by diverse factors. This chapter discusses physical activity determinants in two broad categories: individual characteristics, including motivations, self-efficacy, exercise history, skills, and other health behaviors; and environmental characteristics such as access, cost, and time barriers and social and cultural supports.
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Review |
24 |
297 |
15
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Jeffery RW, Wing RR, Sherwood NE, Tate DF. Physical activity and weight loss: does prescribing higher physical activity goals improve outcome? Am J Clin Nutr 2003; 78:684-9. [PMID: 14522725 DOI: 10.1093/ajcn/78.4.684] [Citation(s) in RCA: 285] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recommending increased physical activity facilitates long-term weight loss, but the optimal level of physical activity to recommend is unknown. OBJECTIVE The objective of the study was to evaluate the efficacy for long-term weight loss of recommendations for much higher physical activity than those normally used in behavioral treatments. DESIGN Overweight men and women (n = 202) were randomly assigned to either a standard behavior therapy (SBT) for obesity, incorporating an energy expenditure (EE) goal of 1000 kcal/wk, or to a high physical activity (HPA) treatment, in which the goal was an EE of 2500 kcal/wk. To help HPA treatment group participants achieve this high exercise goal, their treatment included encouragement to recruit 1-3 exercise partners into the study, personal counseling from an exercise coach, and small monetary incentives. RESULTS The HPA treatment group reported achieving higher mean (+/- SD) physical activity levels than did the SBT group at 6 mo (EE of 2399 +/- 1571 kcal/wk compared with 1837 +/- 1431 kcal/wk), 12 mo (EE of 2249 +/- 1751 kcal/wk compared with 1565 +/- 1309 kcal/wk), and 18 mo (EE of 2317 +/- 1854 kcal/wk compared with 1629 +/- 1483 kcal/wk) (all P < 0.01). Mean (+/- SEM) cumulative weight losses at 6, 12, and 18 mo in the HPA treatment group were 9.0 +/- 7.1, 8.5 +/- 7.9, and 6.7 +/- 8.1 kg, respectively. In the SBT group, the corresponding weight losses were 8.1 +/- 7.4, 6.1 +/- 8.8, and 4.1 +/- 7.3 kg, respectively. Between-group differences in weight loss were significant at 12 and 18 mo. CONCLUSION These results suggest that recommendations of higher levels of physical activity (EE of 2500 kcal/wk) promote long-term weight loss better than do conventional recommendations.
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22 |
285 |
16
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Jeffery RW, Baxter J, McGuire M, Linde J. Are fast food restaurants an environmental risk factor for obesity? Int J Behav Nutr Phys Act 2006; 3:2. [PMID: 16436207 PMCID: PMC1397859 DOI: 10.1186/1479-5868-3-2] [Citation(s) in RCA: 282] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 01/25/2006] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Eating at "fast food" restaurants has increased and is linked to obesity. This study examined whether living or working near "fast food" restaurants is associated with body weight. METHODS A telephone survey of 1033 Minnesota residents assessed body height and weight, frequency of eating at restaurants, and work and home addresses. Proximity of home and work to restaurants was assessed by Global Index System (GIS) methodology. RESULTS Eating at "fast food" restaurants was positively associated with having children, a high fat diet and Body Mass Index (BMI). It was negatively associated with vegetable consumption and physical activity. Proximity of "fast food" restaurants to home or work was not associated with eating at "fast food" restaurants or with BMI. Proximity of "non-fast food" restaurants was not associated with BMI, but was associated with frequency of eating at those restaurants. CONCLUSION Failure to find relationships between proximity to "fast food" restaurants and obesity may be due to methodological weaknesses, e.g. the operational definition of "fast food" or "proximity", or homogeneity of restaurant proximity. Alternatively, the proliferation of "fast food" restaurants may not be a strong unique cause of obesity.
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Journal Article |
19 |
282 |
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French SA, Jeffery RW, Story M, Breitlow KK, Baxter JS, Hannan P, Snyder MP. Pricing and promotion effects on low-fat vending snack purchases: the CHIPS Study. Am J Public Health 2001; 91:112-7. [PMID: 11189801 PMCID: PMC1446491 DOI: 10.2105/ajph.91.1.112] [Citation(s) in RCA: 273] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined the effects of pricing and promotion strategies on purchases of low-fat snacks from vending machines. METHODS Low-fat snacks were added to 55 vending machines in a convenience sample of 12 secondary schools and 12 worksites. Four pricing levels (equal price, 10% reduction, 25% reduction, 50% reduction) and 3 promotional conditions (none, low-fat label, low-fat label plus promotional sign) were crossed in a Latin square design. Sales of low-fat vending snacks were measured continuously for the 12-month intervention. RESULTS Price reductions of 10%, 25%, and 50% on low-fat snacks were associated with significant increases in low-fat snack sales; percentages of low-fat snack sales increased by 9%, 39%, and 93%, respectively. Promotional signage was independently but weakly associated with increases in low-fat snack sales. Average profits per machine were not affected by the vending interventions. CONCLUSIONS Reducing relative prices on low-fat snacks was effective in promoting lower-fat snack purchases from vending machines in both adult and adolescent populations.
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research-article |
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Falkner NH, Neumark-Sztainer D, Story M, Jeffery RW, Beuhring T, Resnick MD. Social, educational, and psychological correlates of weight status in adolescents. OBESITY RESEARCH 2001; 9:32-42. [PMID: 11346665 DOI: 10.1038/oby.2001.5] [Citation(s) in RCA: 264] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The purpose of this research was to examine the social, educational, and psychological correlates of weight status in an adolescent population. It was hypothesized that obese adolescents would differ on psychological, social, and educational variables compared with their non-overweight peers. RESEARCH METHODS AND PROCEDURES In this cross-sectional study, a population-based sample of 4742 male and 5201 female public school students in the 7th, 9th, and 11th grades responded anonymously to a classroom administered questionnaire. Body mass index was calculated from self-reported height and weight and categorized into four classes of weight status: underweight (<15th percentile), average weight (15th to 85th percentile), overweight (>85th to 95th percentile), and obese (>95th percentile). The questionnaire also included questions about social experiences, psychological well-being, educational experiences, and future goals. Associations of weight status with social, psychological, and educational variables and future goals were explored. RESULTS After adjustment for grade level, race, and parental socioeconomic status, obese girls, when compared with their average weight counterparts, were 1.63 (95% confidence interval [CI]: 1.16, 2.30) times less likely to hang out with friends in the last week, 1.49 (95% CI: 1.12, 1.98) times more likely to report serious emotional problems in the last year, 1.79 (95% CI: 1.20, 2.65) times more likely to report hopelessness, and 1.73 (95% CI: 1.21, 1.98) times more likely to report a suicide attempt in the last year. Obese girls were also 1.51 (95% CI: 1.09, 2.10) times more likely to report being held back a grade and 2.09 (95% CI: 1.35, 3.24) times more likely to consider themselves poor students compared with average weight girls. Compared with their average weight counterparts, obese boys were 1.91 (95% CI: 1.43, 2.54) times less likely to hang out with friends in the last week, 1.34 (95% CI: 1.06, 1.70) times more likely to feel that their friends do not care about them, 1.38 (95% CI: 1.08, 1.76) times more likely to report having serious problems in the last year, 1.46 (95% CI: 1.05, 0.03) times more likely to consider themselves poor students, and 2.18 (95% CI: 1.45, 3.30) times more likely to expect to quit school. Compared with average weight boys, underweight boys were 1.67 (95% CI: 1.30, 2.13) times more likely to report hanging out with friends in the last week, 1.22 (95% CI: 1.01, 1.49) times more likely to report disliking school, and 1.40 (95% CI: 1.06, 1.86) times more likely to consider themselves poor students. DISCUSSION Associations of weight status with social relationships, school experiences, psychological well-being, and some future aspirations were observed. Among girls, the pattern of observations indicates that obese girls reported more adverse social, educational, and psychological correlates. Obese as well as underweight boys also reported some adverse social and educational correlates. These findings contribute to an understanding of how adolescent experiences vary by weight status and suggest social and psychological risks associated with not meeting weight and body shape ideals embedded in the larger culture.
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Wing RR, Goldstein MG, Acton KJ, Birch LL, Jakicic JM, Sallis JF, Smith-West D, Jeffery RW, Surwit RS. Behavioral science research in diabetes: lifestyle changes related to obesity, eating behavior, and physical activity. Diabetes Care 2001; 24:117-23. [PMID: 11194216 DOI: 10.2337/diacare.24.1.117] [Citation(s) in RCA: 262] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lifestyle factors related to obesity, eating behavior, and physical activity play a major role in the prevention and treatment of type 2 diabetes. In recent years, there has been progress in the development of behavioral strategies to modify these lifestyle behaviors. Further research, however, is clearly needed, because the rates of obesity in our country are escalating, and changing behavior for the long term has proven to be very difficult. This review article, which grew out of a National Institute of Diabetes and Digestive and Kidney Diseases conference on behavioral science research in diabetes, identifies four key topics related to obesity and physical activity that should be given high priority in future research efforts: 1) environmental factors related to obesity, eating, and physical activity; 2) adoption and maintenance of healthful eating, physical activity, and weight; 3) etiology of eating and physical activity; and 4) multiple behavior changes. This review article discusses the significance of each of these four topics, briefly reviews prior research in each area, identifies barriers to progress, and makes specific research recommendations.
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Review |
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Kumanyika S, Jeffery RW, Morabia A, Ritenbaugh C, Antipatis VJ. Obesity prevention: the case for action. Int J Obes (Lond) 2002; 26:425-36. [PMID: 11896500 DOI: 10.1038/sj.ijo.0801938] [Citation(s) in RCA: 250] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23 |
250 |
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French SA, Epstein LH, Jeffery RW, Blundell JE, Wardle J. Eating behavior dimensions. Associations with energy intake and body weight. A review. Appetite 2012; 59:541-9. [PMID: 22796186 PMCID: PMC3454469 DOI: 10.1016/j.appet.2012.07.001] [Citation(s) in RCA: 230] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/27/2012] [Accepted: 07/01/2012] [Indexed: 01/25/2023]
Abstract
The purpose of this review is to spark integrative thinking in the area of eating behaviors by critically examining research on exemplary constructs in this area. The eating behaviors food responsiveness, enjoyment of eating, satiety responsiveness, eating in the absence of hunger, reinforcing value of food, eating disinhibition and impulsivity/self-control are reviewed in relation to energy intake, body mass index and weight gain over time. Each of these constructs has been developed independently, and little research has explored the extent to which they overlap or whether they differentially predict food choices, energy intake and weight gain in the naturalistic environment. Most available data show positive cross-sectional associations with body mass index, but fewer studies report associations with energy intake or food choices. Little prospective data are available to link measures of eating behaviors with weight gain. Disinhibition has the largest and most consistent body of empirical data that link it prospectively with weight gain. An overarching conceptual model to integrate the conceptual and empirical research base for the role of eating behavior dimensions in the field of obesity research would highlight potential patterns of interaction between individual differences in eating behaviors, specific aspects of the individual's food environment and individual variation in state levels of hunger and satiety.
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Review |
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230 |
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Ikramuddin S, Korner J, Lee WJ, Thomas AJ, Connett JE, Bantle JP, Leslie DB, Wang Q, Inabnet WB, Jeffery RW, Chong K, Chuang LM, Jensen MD, Vella A, Ahmed L, Belani K, Billington CJ. Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c, LDL Cholesterol, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study. JAMA 2018; 319:266-278. [PMID: 29340678 PMCID: PMC5833547 DOI: 10.1001/jama.2017.20813] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE The Roux-en-Y gastric bypass is effective in achieving established diabetes treatment targets, but durability is unknown. OBJECTIVE To compare durability of Roux-en-Y gastric bypass added to intensive lifestyle and medical management in achieving diabetes control targets. DESIGN, SETTING, AND PARTICIPANTS Observational follow-up of a randomized clinical trial at 4 sites in the United States and Taiwan, involving 120 participants who had a hemoglobin A1c (HbA1c) level of 8.0% or higher and a body mass index between 30.0 and 39.9 (enrolled between April 2008 and December 2011) were followed up for 5 years, ending in November 2016. INTERVENTIONS Lifestyle-intensive medical management intervention based on the Diabetes Prevention Program and LookAHEAD trials for 2 years, with and without (60 participants each) Roux-en-Y gastric bypass surgery followed by observation to year 5. MAIN OUTCOMES AND MEASURES The American Diabetes Association composite triple end point of hemoglobin A1c less than 7.0%, low-density lipoprotein cholesterol less than 100 mg/dL, and systolic blood pressure less than 130 mm Hg at 5 years. RESULTS Of 120 participants who were initially randomized (mean age, 49 years [SD, 8 years], 72 women [60%]), 98 (82%) completed 5 years of follow-up. Baseline characteristics were similar between groups: mean (SD) body mass index 34.4 (3.2) for the lifestyle-medical management group and 34.9 (3.0) for the gastric bypass group and had hemoglobin A1c levels of 9.6% (1.2) and 9.6% (1.0), respectively. At 5 years, 13 participants (23%) in the gastric bypass group and 2 (4%) in the lifestyle-intensive medical management group had achieved the composite triple end point (difference, 19%; 95% CI, 4%-34%; P = .01). In the fifth year, 31 patients (55%) in the gastric bypass group vs 8 (14%) in the lifestyle-medical management group achieved an HbA1c level of less than 7.0% (difference, 41%; 95% CI, 19%-63%; P = .002). Gastric bypass had more serious adverse events than did the lifestyle-medical management intervention, 66 events vs 38 events, most frequently gastrointestinal events and surgical complications such as strictures, small bowel obstructions, and leaks. Gastric bypass had more parathyroid hormone elevation but no difference in B12 deficiency. CONCLUSIONS AND RELEVANCE In extended follow-up of obese adults with type 2 diabetes randomized to adding gastric bypass compared with lifestyle and intensive medical management alone, there remained a significantly better composite triple end point in the surgical group at 5 years. However, because the effect size diminished over 5 years, further follow-up is needed to understand the durability of the improvement. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00641251.
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Research Support, N.I.H., Extramural |
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211 |
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Hellerstedt WL, Jeffery RW. The association of job strain and health behaviours in men and women. Int J Epidemiol 1997; 26:575-83. [PMID: 9222783 DOI: 10.1093/ije/26.3.575] [Citation(s) in RCA: 204] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This study examined whether self-reported job strain, defined by the Karasek model was associated with some early, potentially modifiable cardiovascular (CVD)-related health characteristics. METHODS Data were gathered in a 1989 cross-sectional survey of 3843 randomly selected men and women employees of 32 worksites in Minnesota. Sex-stratified crude and multivariate analyses examined the independent association of job psychological demands, latitude, and the combination of these two job domains (i.e. strain), to body mass index (BMI), smoking, exercise, and dietary fat intake. RESULTS Job demands was positively associated with smoking, smoking intensity, and high fat intake in men and with BMI and smoking intensity in women. Job latitude was positively associated with exercise in men and women. High-strain men smokers smoked more than other workers and high-strain women had higher BMI than other women. CONCLUSIONS Overall, self-reported job demands, latitude, and job strain were associated with some CVD-related health characteristics, but the effects were not similar in magnitude or direction for all characteristics and they varied by sex.
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Ball K, Jeffery RW, Abbott G, McNaughton SA, Crawford D. Is healthy behavior contagious: associations of social norms with physical activity and healthy eating. Int J Behav Nutr Phys Act 2010; 7:86. [PMID: 21138550 PMCID: PMC3018448 DOI: 10.1186/1479-5868-7-86] [Citation(s) in RCA: 202] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 12/07/2010] [Indexed: 12/02/2022] Open
Abstract
Background Social norms are theoretically hypothesized to influence health-related behaviors such as physical activity and eating behaviors. However, empirical evidence relating social norms to these behaviors, independently of other more commonly-investigated social constructs such as social support, is scarce and findings equivocal, perhaps due to limitations in the ways in which social norms have been conceptualized and assessed. This study investigated associations between clearly-defined social norms and a range of physical activity and eating behaviors amongst women, adjusting for the effects of social support. Methods Self-report survey data about particular physical activity (leisure-time moderate-vigorous activity; volitional walking; cycling for transport) and eating behaviors (fast food, soft drink and fruit and vegetable consumption), and social norms and support for these, were provided by 3,610 women aged 18-46 years living in socioeconomically disadvantaged neighborhoods in Victoria, Australia. Results Results of regression analyses showed that social norms for physical activity and eating behaviors predicted these respective behaviors relatively consistently; these associations generally remained significant after adjustment for social support. Conclusions Acknowledging the cross-sectional study design, these data confirm theoretical accounts of the importance of social norms for physical activity and eating behaviors, and suggest that this is independent from social support. Intervention strategies aimed at promoting physical activity and healthy eating could incorporate strategies aimed at modifying social norms relating to these behaviors.
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Journal Article |
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202 |
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French SA, Story M, Jeffery RW, Snyder P, Eisenberg M, Sidebottom A, Murray D. Pricing strategy to promote fruit and vegetable purchase in high school cafeterias. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1997; 97:1008-10. [PMID: 9284880 DOI: 10.1016/s0002-8223(97)00242-3] [Citation(s) in RCA: 196] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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196 |