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Jakicic JM, Apovian CM, Barr-Anderson DJ, Courcoulas AP, Donnelly JE, Ekkekakis P, Hopkins M, Lambert EV, Napolitano MA, Volpe SL. Physical Activity and Excess Body Weight and Adiposity for Adults. American College of Sports Medicine Consensus Statement. Med Sci Sports Exerc 2024; 56:2076-2091. [PMID: 39277776 DOI: 10.1249/mss.0000000000003520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
ABSTRACT Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus paper on the role of physical activity in the prevention of weight gain in 2019. This current consensus paper serves as an additional update to those prior ACSM position and consensus papers. The ACSM supports the inclusion of physical activity in medical treatments (pharmacotherapy, metabolic and bariatric surgery) of excess weight and adiposity, as deemed to be medically appropriate, and provides perspectives on physical activity within these therapies. For weight loss and prevention of weight gain, the effects may be most prevalent when physical activity is progressed in an appropriate manner to at least 150 min·wk-1 of moderate-intensity physical activity, and these benefits occur in a dose-response manner. High-intensity interval training does not appear to be superior to moderate-to-vigorous physical activity for body weight regulation, and light-intensity physical activity may also be an alternative approach provided it is of sufficient energy expenditure. Evidence does not support that any one single mode of physical activity is superior to other modes for the prevention of weight gain or weight loss, and to elicit holistic health benefits beyond the effects on body weight and adiposity, multimodal physical activity should be recommended. The interaction between energy expenditure and energy intake is complex, and the effects of exercise on the control of appetite are variable between individuals. Physical activity interventions should be inclusive and tailored for sex, self-identified gender, race, ethnicity, socioeconomic status, age, and developmental level. Intervention approaches can also include different forms, channels, and methods to support physical activity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Stella L Volpe
- Virginia Polytechnic Institute and State University, Blacksburg, VA
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Bauer S, Reiter L, Weijs PJM, Schoufour JD, Boirie Y, Topinková E, Memelink RG, Verreijen AM, Borenich A, Eglseer D. Adherence to resistance training and hypocaloric diet among persons near retirement age - A secondary data analysis of three randomized controlled trials. J Nutr Health Aging 2024; 28:100344. [PMID: 39191118 DOI: 10.1016/j.jnha.2024.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES Adherence to lifestyle interventions is crucial for the treatment of obesity. However, there is little research about adherence to lifestyle interventions in persons around retirement age. The objectives of this study are (1) to identify factors associated with the adherence to resistance training and a hypocaloric diet and (2) to describe the association between adherence and changes in body composition outcome parameters. DESIGN This secondary data analysis included three randomized controlled trials. SETTING & PARTICIPANTS The inclusion criteria of the participants were an age of 55-75 years, a BMI ≥ 25 kg/m2 and receiving both a hypocaloric diet and resistance training. All participants were residing in the community. MEASUREMENTS Adherence to hypocaloric diet was measured through the mean dietary intake on the basis of a 3-day dietary record. If the participant consumed at least 600 kcal less than the individual caloric requirements, they were considered adherent. Adherence to resistance training was achieved if ≥67% of the recommended training sessions were attended over the course of the study periods. RESULTS 232 participants were included, 47.0% female, mean age 64.0 (±5.5) years. 80.2% adhered to resistance training and 51.3% adhered to a hypocaloric diet. Older age (Beta 0.41; 95% CI 0.05, 0.78; p = 0.028) and male sex (Beta 7.7; 95% CI 3.6, 11; p < 0.001) were associated with higher resistance training adherence. A higher BMI at baseline (Beta 6.4; 95% CI 3.6, 9.2; p < 0.001) and male sex (Beta 65; 95% CI 41, 88; p < 0.001) were associated with higher adherence to hypocaloric diet. CONCLUSION We identified several associated factors (sex, age and BMI at baseline) that should be considered to promote adherence in future lifestyle intervention studies in persons around retirement age. We recommend including behavior change techniques in lifestyle interventions and consider sex-specific interventions to improve the adherence of women.
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Affiliation(s)
- S Bauer
- Medical University of Graz, Institute of Nursing Science, Neue Stiftingtalstraße 6 P06 WEST, 8010 Graz, Graz, Austria
| | - L Reiter
- Medical University of Graz, Institute of Nursing Science, Neue Stiftingtalstraße 6 P06 WEST, 8010 Graz, Graz, Austria
| | - P J M Weijs
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dr Meurerlaan 8, 1067 SM, Amsterdam, The Netherlands; Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam Public Health Institute, VU University, Amsterdam, The Netherlands
| | - J D Schoufour
- Faculty of Sports and Nutrition, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dr Meurerlaan 8, 1067 SM, Amsterdam, The Netherlands
| | - Y Boirie
- University Clermont Auvergne, Human Nutrition Unit, INRA, CRNH Auvergne, CHU Clermont-Ferrand, Clinical Nutrition Department, 28 Place Henri Dunant, 63001 CLERMONT-FERRAND Cedex 1, Clermont-Ferrand, France
| | - E Topinková
- Charles University, First Faculty of Medicine, Department of Geriatric Medicine, Katerinska 1660/32, 12108 Nove Mesto, Praha, Czech Republic
| | - R G Memelink
- Amsterdam University of Applied Sciences, Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Dr. Meurerlaan 8/1067 SM Amsterdam, Amsterdam, The Netherlands
| | - A M Verreijen
- HAS Green Academy, Onderwijsboulevard 221, 5223 DE' s-Hertogenbosch, DE 's-Hertogenbosch, The Netherlands
| | - A Borenich
- Medical University of Graz, Institute of Medical Informatics, Statistics and Documentation, Auenbruggerplatz 2, 8010 Graz, Graz, Austria
| | - D Eglseer
- Medical University of Graz, Institute of Nursing Science, Neue Stiftingtalstraße 6 P06 WEST, 8010 Graz, Graz, Austria.
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Carpenter SM, Shetty A, Hetzel SJ, Garza K, Porter LS, Gray KE, Shaw RJ, Lewis MA, Mao L, Pabich S, Johnson HM, Yancy WS, Elwert F, Voils CI. A non-randomized comparison of engagement and outcomes for in-person versus virtual delivery of the Partner2Lose weight management trial. Obes Sci Pract 2024; 10:e778. [PMID: 39045420 PMCID: PMC11265462 DOI: 10.1002/osp4.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/11/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
Objective Existing behavioral weight management interventions produce clinically meaningful weight loss. The onset of the COVID-19 pandemic led to the quick transition of such interventions from in-person to virtual platforms. This provided a unique opportunity to compare engagement and outcomes for an in-person versus virtually delivered weight management intervention. Methods A non-randomized comparison of engagement and weight outcomes was performed between two cohorts who participated in a weight management intervention in person (N = 97) versus three who participated virtually via videoconference (N = 134). Various metrics of engagement were examined, including group class and individual phone call attendance and duration, and retention for weight assessments. Behavioral targets of daily caloric intake and step-counts and the clinical weight outcome were explored. Results Cohorts (mean [standard deviation] age 47.3 (11.5), 67.1% women: 86.8% White) that participated virtually attended more group sessions (p < 0.001) and had maintenance telephone calls that were of a longer duration (p < 0.001). No other engagement or weight outcomes significantly differed by delivery modality. Conclusions Virtual weight management programs are promising and may generate similar outcomes to those delivered in-person. Future research should seek to understand how best to promote and sustain engagement in virtual interventions.
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Affiliation(s)
| | - Armaan Shetty
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Scott J. Hetzel
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Katya Garza
- Department of SurgerySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Laura S. Porter
- Psychiatry & Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Kristen E. Gray
- Department of Veterans Affairs Puget Sound Health Care SystemHealth Services Research & DevelopmentSeattleWashingtonUSA
- Health Systems and Population HealthSchool of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Ryan J. Shaw
- School of NursingDuke UniversityDurhamNorth CarolinaUSA
| | - Megan A. Lewis
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Lu Mao
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Samantha Pabich
- Department of MedicineSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- William S Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Heather M. Johnson
- Christine E. Lynn Women's Health & Wellness InstituteBaptist Health South FloridaCharles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFloridaUSA
| | - William S. Yancy
- Department of MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Felix Elwert
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of SociologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Corrine I. Voils
- Department of SurgerySchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- William S Middleton Memorial Veterans HospitalMadisonWisconsinUSA
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Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M, Al-Obaid H, Rourke J, Asghari S, Hall A. Interventions to improve primary healthcare in rural settings: A scoping review. PLoS One 2024; 19:e0305516. [PMID: 38990801 PMCID: PMC11239038 DOI: 10.1371/journal.pone.0305516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations. OBJECTIVE Synthesize and categorize studies that examine interventions to improve rural primary care. ELIGIBILITY CRITERIA Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison. SOURCES OF EVIDENCE Pubmed, CINAHL, Cochrane Library, Embase. CHARTING METHODS We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant. RESULTS 372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997-99 to a peak of 49 papers in 2017. CONCLUSIONS Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.
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Affiliation(s)
- Kris Aubrey-Basler
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Krystal Bursey
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Bradley Furlong
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mark Howells
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Harith Al-Obaid
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - James Rourke
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Brady RE, Lyons KD, Stevens CJ, Godzik CM, Smith AJ, Bagley PJ, Vitale EJ, Bernstein SL. Implementing evidence-based practices in rural settings: a scoping review of theories, models, and frameworks. FRONTIERS IN HEALTH SERVICES 2024; 4:1326777. [PMID: 39036464 PMCID: PMC11258036 DOI: 10.3389/frhs.2024.1326777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 06/10/2024] [Indexed: 07/23/2024]
Abstract
Background Rural healthcare has unique characteristics that affect the dissemination and implementation of evidence-based interventions. Numerous theories, models, and frameworks have been developed to guide implementation of healthcare interventions, though not specific to rural healthcare. The present scoping review sought to identify the theories, models, and frameworks most frequently applied to rural health and propose an approach to rural health research that harnesses selected constructs from these theories, models, and frameworks. This resulting synthesis can serve as a guide to researchers, policy makers, and clinicians seeking to employ commonly used theories, models, and frameworks to rural health. Methods We used the Scopus abstract indexing service to identify peer-reviewed literature citing one or more of theories, models, or frameworks used in dissemination and implementation research and including the word "rural" in the Title, Abstract, or Keywords. We screened the remaining titles and abstracts to ensure articles met additional inclusion criteria. We conducted a full review of the resulting 172 articles to ensure they identified one or more discrete theory, model, or framework applied to research or quality improvement projects. We extracted the theories, models, and frameworks and categorized these as process models, determinant frameworks, classic theories, or evaluation frameworks. Results We retained 61 articles of which 28 used RE-AIM, 11 used Community-Based Participatory Research (CBPR) framework, eight used the Consolidated Framework for Implementation Research (CFIR), and six used the integrated-Promoting Action on Research Implementation in Health Services (iPARIHS). Additional theories, models, and frameworks were cited in three or fewer reports in the literature. The 14 theories, models, and frameworks cited in the literature were categorized as seven process models, four determinant frameworks, one evaluation framework, and one classic theory. Conclusions The RE-AIM framework was the most frequently cited framework in the rural health literature, followed by CBPR, CFIR, and iPARIHS. A notable advantage of RE-AIM in rural healthcare settings is the focus on reach as a specified outcome, given the challenges of engaging a geographically diffuse and often isolated population. We present a rationale for combining the strengths of these theories, models, and frameworks to guide a research agenda specific to rural healthcare research. Systematic Review Registration https://osf.io/fn2cd/.
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Affiliation(s)
- Robert E. Brady
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Kathleen D. Lyons
- Department of Occupational Medicine, Massachusetts General Hospital Institute of Health Professions, Boston, MA, United States
| | - Courtney J. Stevens
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Cassandra M. Godzik
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Andrew J. Smith
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, Colorado Springs, CO, United States
| | - Pamela J. Bagley
- Biomedical Libraries, Dartmouth College, Hanover, NH, United States
| | - Elaina J. Vitale
- Biomedical Libraries, Dartmouth College, Hanover, NH, United States
| | - Steven L. Bernstein
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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JOLIN JAMESRENÉ, KWON MINSOO, BROCK ELIZABETH, CHEN JONATHAN, KOKAN AISHA, MURDOCK RYAN, STANFORD FATIMACODY. Policy Interventions to Enhance Medical Care for People With Obesity in the United States-Challenges, Opportunities, and Future Directions. Milbank Q 2024; 102:336-350. [PMID: 38332667 PMCID: PMC11176406 DOI: 10.1111/1468-0009.12693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/08/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
Policy Points Health policymakers have insufficiently addressed care for people with obesity (body mass index ≥ 30 kg/m2) in the United States. Current federal policies targeting obesity medications reflect this unfortunate reality. We argue for a novel policy framework to increase access to effective obesity therapeutics and care, recognizing that, though prevention is critical, the epidemic proportions of obesity in the United States warrant immediate interventions to augment care. Reducing barriers to and improving the quality of existing anti-obesity medications, intensive behavioral therapy, weight management nutrition and dietary counseling, and bariatric surgery are critical. Moreover, to ensure continuity of care and patient-clinician trust, combating physician and broader weight stigma must represent a central component of any viable obesity care agenda.
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Affiliation(s)
| | | | | | | | - AISHA KOKAN
- Harvard University
- Global Health and Health PolicyHarvard University
| | | | - FATIMA CODY STANFORD
- MGH Weight CenterMassachusetts General HospitalNutrition Obesity Research Center at Harvard, Harvard Medical School
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7
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Shariq K, Siddiqi TJ, Van Spall H, Greene SJ, Fudim M, DeVore AD, Pandey A, Butler J, Khan MS. Role of telemedicine in the management of obesity: State-of-the-art review. Obes Rev 2024; 25:e13734. [PMID: 38528833 DOI: 10.1111/obr.13734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
Obesity is a worsening public health epidemic that remains challenging to manage. Obesity substantially increases the risk of cardiovascular diseases and presents a significant financial burden on the healthcare system. Digital health interventions, specifically telemedicine, may offer an attractive and viable solution for managing obesity. During the COVID-19 pandemic, the need for a safer alternative to in-person visits led to the increased popularity of telemedicine. Multiple studies have tested the efficacy of telemedicine modalities, including digital coaching via videoconferencing sessions, e-health monitoring using wearable devices, and asynchronous forms of communication such as online chatrooms with counselors. In this review, we discuss the available evidence for telemedicine interventions in managing obesity, review current challenges and barriers to using telemedicine, and outline future directions to optimize the management of patients with obesity using telemedicine.
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Affiliation(s)
- Kainat Shariq
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississipi, USA
| | - Harriette Van Spall
- Division of Cardiology, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Marat Fudim
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Adam D DeVore
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississipi, USA
- Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
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McCarthy J, Psaros C, Wexler DJ, Delahanty LM. Medical Nutrition Therapy, In-Person, or Telephone Group Lifestyle Intervention for Type 2 Diabetes? A Qualitative Study of Patient Perceptions and Treatment Preferences. Sci Diabetes Self Manag Care 2024; 50:130-140. [PMID: 38454626 DOI: 10.1177/26350106241232635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
PURPOSE The purpose of the study was to explore the thoughts, feelings, motivations, and assignment preferences of community health center patients with type 2 diabetes considering participation in a 2-year lifestyle intervention trial aimed at weight loss and increased physical activity. The reasons for patients' delivery mode preferences were also explored to aid in the design of future interventions for controlled trials. METHODS Using structured telephone interview guides, 57 patients with type 2 diabetes receiving primary care at 3 community health centers affiliated with an academic medical center were interviewed regarding the perceived pros and cons of each of the 3 possible treatment assignments: telephone conference group, in-person group, or individual medical nutrition therapy. The interview data were organized using NVIVO and analyzed using content analysis. Findings on whether preferences varied by age, gender, or diabetes duration were also examined. RESULTS Six categories related to patient treatment preferences were identified: (1) perception of time, (2) learning style, (3) comfort, (4) prior experience with weight loss programs and conference calls, (5) desire for support/idea exchange, and (6) accountability. Preferences did not seem to vary by age, gender, or diabetes duration. CONCLUSIONS Key factors influencing preference of treatment assignment included schedule demands, belief about learning style, and past experiences. These findings demonstrate the importance of having a variety of nutrition and lifestyle treatment options available to meet the needs of people with type 2 diabetes.
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Affiliation(s)
- Jeanna McCarthy
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Deborah J Wexler
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Linda M Delahanty
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Gorczyca AM, Washburn RA, Ptomey LT, Mayo MS, Krebill R, Sullivan DK, Gibson CA, Stolte S, Donnelly JE. Weight management in rural health clinics: Results from the randomized midwest diet and exercise trial. Obes Sci Pract 2024; 10:e753. [PMID: 38660371 PMCID: PMC11042259 DOI: 10.1002/osp4.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Rural living adults have higher rates of obesity compared with their urban counterparts and less access to weight management programs. Previous research studies have demonstrated clinically relevant weight loss in rural living adults who complete weight management programs delivered by university affiliated interventionists. However, this approach limits the potential reach, adoption, implementation, and maintenance of weight management programs for rural residents. Weight management delivered through rural health clinics by non-physician clinic associated staff, for example, nurses, registered dieticians, allied health professionals, etc. has the potential to improve access to weight management for rural living adults. This trial compared the effectiveness of a 6-month multicomponent weight management intervention for rural living adults delivered using group phone calls (GP), individual phone calls (IP) or an enhanced usual care control (EUC) by rural clinic associated staff trained by our research team. Methods Rural living adults with overweight/obesity (n = 187, age ∼ 50 years 82% female, body mass index ∼35 kg/m2) were randomized (2:2:1) to 1 of 3 intervention arms: GP, which included weekly ∼ 45 min sessions with 7-14 participants (n = 71), IP, which included weekly ∼ 15 min individual sessions (n = 80), or EUC, which included one-45 min in-person session at baseline. Results Weight loss at 6 months was clinically relevant, that is, ≥5% in the GP (-11.4 kg, 11.7%) and the IP arms (-9.1 kg, 9.2%) but not in the EUC arm (-2.6%, -2.5% kg). Specifically, 6 month weight loss was significantly greater in the IP versus EUC arms (-6.5 kg. p ≤ 0.025) but did not differ between the GP and IP arms (-2.4 kg, p > 0.025). The per participant cost per kg. weight loss for implementing the intervention was $93 and $60 for the IP and GP arms, respectively. Conclusions Weight management delivered by interventionists associated with rural health clinics using both group and IP calls results in clinically relevant 6 months weight loss in rural dwelling adults with overweight/obesity with the group format offering the most cost-effective strategy. Clinical trial registration: ClinicalTrials.gov (NCT02932748).
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Affiliation(s)
- Anna M. Gorczyca
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Richard A. Washburn
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Lauren T. Ptomey
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Matthew S. Mayo
- Department of Biostatistics & Data ScienceThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Ron Krebill
- Department of Biostatistics & Data ScienceThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Debra K. Sullivan
- Department of Dietetics and NutritionThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Cheryl A. Gibson
- Department of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Sarah Stolte
- Department of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Joseph E. Donnelly
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
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10
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Jensen RA, Befort CA. Cancer Prevention Perspective: The University of Kansas Cancer Center. Cancer Prev Res (Phila) 2023; 16:643-647. [PMID: 38037383 PMCID: PMC10695279 DOI: 10.1158/1940-6207.capr-22-0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 12/02/2023]
Abstract
Despite the incredible progress that has been made against cancer over the last few decades, the demographic trends in the United States predict that we will see significant increases in cancer incidence and mortality by the year 2030. This, coupled with an aging cancer workforce, would suggest that we will have major challenges ahead in dealing with the increasing burden from cancer. Clearly a critical part of our strategy must be to focus on cancer prevention and control (CPC) efforts and not solely rely on treatment to mitigate this concerning trend. This review discusses how the University of Kansas Cancer Center has had a longstanding emphasis on CPC and has leveraged this expertise to enhance the effectiveness and impact of our community outreach and engagement efforts.
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Affiliation(s)
- Roy A. Jensen
- Vice Chancellor and Director, The University of Kansas Cancer Center; William R. Jewell Distinguished Kansas Masonic Professor of Cancer Research and Director, Kansas Masonic Cancer Research Institute; Professor, Department of Pathology and Laboratory Medicine, Department of Cancer Biology, University of Kansas Medical Center, Kansas City, Kansas
| | - Christie A. Befort
- Associate Director for Cancer Prevention and Control, The University of Kansas Cancer Center; Professor, Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas
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Abstract
Lifestyle intervention is an alluring concept. Changing behaviors to reduce food intake and increase energy expenditure will reduce body weight and body fat. Large randomized clinical trials in academic settings demonstrate lifestyle intervention can produce weight loss and significant health benefits. However, they also demonstrate the problems-not all participants are able to lose even 5%, and weight regain is common. Studies conducted in real-world settings achieve modest weight loss, but no reimbursement model supports it. Health care providers need to understand the benefits and limitations of lifestyle intervention delivery in the medical office setting.
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Affiliation(s)
- Donna H Ryan
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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12
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Katzmarzyk PT. Addressing Obesity: Implementing Evidence-Based Lifestyle Prevention and Treatment Strategies in Clinical Practice. Med Clin North Am 2023; 107:1025-1034. [PMID: 37806722 DOI: 10.1016/j.mcna.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
The prevalence of obesity continues to increase in the United States and globally, placing a large portion of the population at an increased risk of metabolic and cardiovascular diseases. Primary care settings remain the main access point for medical care and preventive medical services for most individuals and thus represent a key environment for treating and managing obesity. Several recent pragmatic trials conducted in primary care have demonstrated clinically significant weight loss and associated reductions in chronic disease risk factors, highlighting the need to translate these programs into mainstream clinical care.
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Affiliation(s)
- Peter T Katzmarzyk
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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13
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Kramer ES, Deffenbacher B, Staton EW, Smith PC, Summers Holtrop J. The Weight-Prioritized Visit: An Idea Whose Time Has Come. FAMILY PRACTICE MANAGEMENT 2023; 30:19-25. [PMID: 37963258 PMCID: PMC11182608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
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14
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Herbert J, Schumacher T, Brown LJ, Clarke ED, Collins CE. Delivery of telehealth nutrition and physical activity interventions to adults living in rural areas: a scoping review. Int J Behav Nutr Phys Act 2023; 20:110. [PMID: 37715234 PMCID: PMC10504780 DOI: 10.1186/s12966-023-01505-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/20/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Lifestyle behaviours related to smoking, alcohol, nutrition, and physical activity are leading risk factors for the development of chronic disease. For people in rural areas, access to individualised lifestyle services targeting behaviour change may be improved by using telehealth. However, the scope of literature investigating telehealth lifestyle behaviour change interventions for rural populations is unknown, making it difficult to ascertain whether telehealth interventions require adaptation for rural context via a systematic review. This scoping review aimed to address this gap, by mapping existing literature describing telehealth lifestyle interventions delivered to rural populations to determine if there is scope for systematic review of intervention effectiveness in this research topic. METHODS The PRISMA extension for scoping review checklist guided the processes of this scoping review. A search of eight electronic databases reported in English language until June 2023 was conducted. Eligible studies included adults (18 years and over), who lived in rural areas of high-income countries and undertook at least one synchronous (video or phone consultation) telehealth intervention that addressed either addictive (smoking or alcohol), or non-addictive lifestyle behaviours (nutrition or physical activity). Studies targeting addictive and non-addictive behaviours were separated after full text screening to account for the involvement of addictive substances in smoking and alcohol studies that may impact behaviour change interventions described. Studies targeting nutrition and/or physical activity interventions are presented here. RESULTS The search strategy identified 17179 citations across eight databases, with 7440 unique citations once duplicates were removed. Full texts for 492 citations were retrieved and screened for inclusion with 85 publications reporting on 73 studies eligible for data extraction and analysis. Of this, addictive behaviours were comprised of 15 publications from 13 studies. Non-addictive behaviours included 70 publications from 58 studies and are reported here. Most interventions were delivered within the United States of America (n = 43, 74.1%). The most common study design reported was Randomised Control Trial (n = 27, 46.6%). Included studies involved synchronous telehealth interventions targeting nutrition (11, 18.9%), physical activity (5, 8.6%) or nutrition and physical activity (41, 70.7%) and were delivered predominately via videoconference (n = 17, 29.3%). CONCLUSIONS Despite differences in intervention characteristics, the number of randomised control trials published suggests sufficient scope for future systematic reviews to determine intervention effectiveness related to nutrition and physical activity telehealth interventions for rural populations. TRIAL REGISTRATION The scoping review protocol was not pre-registered.
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Affiliation(s)
- Jaimee Herbert
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Tracy Schumacher
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Leanne J Brown
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Erin D Clarke
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, ATC 205, ATC Building, University Drive Callaghan, Newcastle, NSW, 2308, Australia
| | - Clare E Collins
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, ATC 310, ATC Building, University Drive Callaghan, Newcastle, NSW, 2308, Australia.
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15
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Zhang X, DeScenza VR, Chaplow ZL, Kilar M, Bowman J, Buga A, Kackley ML, Shoben AB, Felix AS, Paskett ED, Focht BC. Effect of a Telephone-Based Lifestyle Intervention on Weight, Body Composition, and Metabolic Biomarkers in Rural Ohio: Results from a Randomized Pilot Study. Nutrients 2023; 15:3998. [PMID: 37764780 PMCID: PMC10538144 DOI: 10.3390/nu15183998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Rural residents experience higher rates of obesity, obesity-related chronic diseases, and poorer lifestyle. Promoting physical activity and healthy eating are critical for rural residents; however, lack of resources and access barriers limit the feasibility of in-person lifestyle interventions. There is a need to design and deliver remotely accessible lifestyle interventions in this population. This pilot study examined the effect of a telephone-based lifestyle intervention on weight, body composition, lipids, and inflammatory biomarkers among rural Ohio residents. Rural Ohio adults with overweight/obesity (n = 40) were 2:1 randomized to a 15-week telephone-based lifestyle intervention (n = 27) or control group (n = 13). The lifestyle intervention group received weekly telephone counseling sessions emphasizing healthy eating and increasing physical activity. The control group received educational brochures describing physical activity and dietary recommendations. Weight, body composition, fasting blood lipids, and inflammatory biomarkers were objectively measured at baseline and 15 weeks at local community centers (trial registration#: NCT05040152 at ClinicalTrial.gov). Linear mixed models were used to examine change over time by group. Participants were mostly female, with an average age of 49 years. Over the 15-week trial, the lifestyle intervention showed superior improvements in total cholesterol (∆ = -18.7 ± 7.8 mg/dL, p = 0.02) and LDL (∆ = -17.1 ± 8.1 mg/dL, p = 0.04) vs. control, whereas no significant between-group differences in weight, body composition, or inflammation were observed. Our findings suggest that a 15-week telephone-based lifestyle intervention may offer metabolic benefits that reduce disease risk in rural adults with obesity. Future large-scale studies are needed to determine the efficacy of remotely accessible lifestyle interventions in rural populations, with the goal of reducing obesity-related disparities.
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Affiliation(s)
- Xiaochen Zhang
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (X.Z.); (E.D.P.)
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA;
- Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Victoria R. DeScenza
- Kinesiology, College of Agriculture, Health, and Natural Resource, University of Connecticut, Storrs, CT 06268, USA;
| | - Zachary L. Chaplow
- Kinesiology, Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (Z.L.C.); (M.K.); (J.B.); (A.B.); (M.L.K.)
| | - Megan Kilar
- Kinesiology, Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (Z.L.C.); (M.K.); (J.B.); (A.B.); (M.L.K.)
| | - Jessica Bowman
- Kinesiology, Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (Z.L.C.); (M.K.); (J.B.); (A.B.); (M.L.K.)
| | - Alex Buga
- Kinesiology, Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (Z.L.C.); (M.K.); (J.B.); (A.B.); (M.L.K.)
| | - Madison L. Kackley
- Kinesiology, Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (Z.L.C.); (M.K.); (J.B.); (A.B.); (M.L.K.)
| | - Abigail B. Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA;
| | - Ashley S. Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA;
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (X.Z.); (E.D.P.)
| | - Brian C. Focht
- Kinesiology, Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (Z.L.C.); (M.K.); (J.B.); (A.B.); (M.L.K.)
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Campbell K, Greenfield G, Li E, O'Brien N, Hayhoe B, Beaney T, Majeed A, Neves AL. The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review. J Med Internet Res 2023; 25:e48920. [PMID: 37647117 PMCID: PMC10500356 DOI: 10.2196/48920] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality. OBJECTIVE This study aims to evaluate the impact of virtual consultations on the quality of primary care. METHODS A total of 6 databases were searched. Studies that evaluated the impact of virtual consultations, for any disease, were included. Title and abstract screening and full-text screening were performed by 2 pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed. RESULTS In total, 30 studies (5,469,333 participants) were included in this review. Our findings suggest that virtual consultations are equally effective to or more effective than face-to-face care for the management of certain conditions, including mental illness, excessive smoking, and alcohol consumption. Overall, 4 studies indicated positive impacts on some aspects of patient-centeredness; however, a negative impact was noted on patients' perceived autonomy support (ie, the degree to which people perceive those in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care settings. Evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities among other subgroups depending on contextual factors. CONCLUSIONS Our systematic review demonstrated that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalizing on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies.
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Affiliation(s)
- Kate Campbell
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Edmond Li
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Niki O'Brien
- Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ana Luísa Neves
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Beasley JM, Johnston EA, Sevick MA, Jay M, Rogers ES, Zhong H, Zabar S, Goldberg E, Chodosh J. Study protocol: BRInging the Diabetes prevention program to GEriatric Populations. Front Med (Lausanne) 2023; 10:1144156. [PMID: 37275370 PMCID: PMC10232977 DOI: 10.3389/fmed.2023.1144156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023] Open
Abstract
In the Diabetes Prevention Program (DPP) randomized, controlled clinical trial, participants who were ≥ 60 years of age in the intensive lifestyle (diet and physical activity) intervention had a 71% reduction in incident diabetes over the 3-year trial. However, few of the 26.4 million American adults age ≥65 years with prediabetes are participating in the National DPP. The BRInging the Diabetes prevention program to GEriatric Populations (BRIDGE) randomized trial compares an in-person DPP program Tailored for Older AdulTs (DPP-TOAT) to a DPP-TOAT delivered via group virtual sessions (V-DPP-TOAT) in a randomized, controlled trial design (N = 230). Eligible patients are recruited through electronic health records (EHRs) and randomized to the DPP-TOAT or V-DPP-TOAT arm. The primary effectiveness outcome is 6-month weight loss and the primary implementation outcome is intervention session attendance with a non-inferiority design. Findings will inform best practices in the delivery of an evidence-based intervention.
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Affiliation(s)
- Jeannette M Beasley
- Department of Nutrition and Food Studies, New York University, New York, NY, United States
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Emily A Johnston
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, Institute for Excellence in Health Equity, New York University, New York, NY, United States
| | - Melanie Jay
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, Institute for Excellence in Health Equity, New York University, New York, NY, United States
- VA New York Harbor Healthcare System, Medicine Service, New York, NY, United States
| | - Erin S Rogers
- Department of Population Health, Institute for Excellence in Health Equity, New York University, New York, NY, United States
| | - Hua Zhong
- Department of Population Health, Institute for Excellence in Health Equity, New York University, New York, NY, United States
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Eric Goldberg
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Joshua Chodosh
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, Institute for Excellence in Health Equity, New York University, New York, NY, United States
- VA New York Harbor Healthcare System, Medicine Service, New York, NY, United States
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18
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Goessl CL, VanWormer JJ, Pathak RD, Ellerbeck EF, Kurz DL, Befort CA. Weight change and mental health status in a behavioral weight loss trial. J Affect Disord 2023; 334:302-306. [PMID: 37156276 DOI: 10.1016/j.jad.2023.04.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/12/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Obesity, depression, and anxiety often co-occur, but research on weight change and mental health status is limited. This analysis examined how the mental component score (MCS-12) from the Short Form health survey changed over 24 months in weight loss trial participants with vs. without treatment seeking for affective symptoms (TxASx) and by weight change quintiles. METHODS Participants with complete data (n = 1163) were analyzed from enrollees in a cluster-randomized, behavioral weight loss trial in rural U.S. Midwestern primary care practices. Participants received a lifestyle intervention with different delivery models, including in-clinic individual, in-clinic group, or telephone group counseling visits. Participants were stratified by baseline TxASx status and 24-month weight change quintiles. Mixed models were used to estimate MCS-12 scores. RESULTS There was a significant group-by-time interaction at the 24-month follow-up. The largest 0-24 month increase in MCS-12 scores (+5.3 points [12 %]) was observed in participants with TxASx who lost the most weight during the trial, while the largest decrease in MCS-12 scores (-1.8 points [-3 %]) was observed in participants without TxASx who gained the most weight (p < 0.001). LIMITATIONS Notable limitations included self-reported mental health, the observational analytical design, and a largely homogenous source population, as well as the possibility of reverse causation biasing some findings. CONCLUSIONS Mental health status generally improved, particularly among participants with TxASx who experienced significant weight loss. Those without TxASx who gained weight, however, had a decline in mental health status over 24 months. Replication of these findings is warranted.
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Affiliation(s)
- Cody L Goessl
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology & Population Health, Marshfield, WI, USA; Marshfield Clinic-Marshfield Medical Center, Department of Occupational Medicine, Marshfield, WI, USA
| | - Jeffrey J VanWormer
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology & Population Health, Marshfield, WI, USA.
| | - Ram D Pathak
- Marshfield Clinic-Marshfield Medical Center, Department of Endocrinology, Marshfield, WI, USA
| | - Edward F Ellerbeck
- University of Kansas Medical Center, Department of Population Health, Kansas City, KS, USA
| | - Daniel L Kurz
- University of Kansas Medical Center, Department of Population Health, Kansas City, KS, USA
| | - Christie A Befort
- University of Kansas Medical Center, Department of Population Health, Kansas City, KS, USA
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19
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Bricker JB, Mull KE, Sullivan BM, Forman EM, Lillis J, McTiernan A, Santiago-Torres M. Telehealth acceptance and commitment therapy for weight loss: Protocol of the WeLNES full scale randomized controlled trial. Contemp Clin Trials 2023; 126:107091. [PMID: 36682490 PMCID: PMC9998365 DOI: 10.1016/j.cct.2023.107091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Behavioral interventions delivered via one-on-one telephone coaching (hereafter referred to as telehealth) for weight loss have had great population-level reach but to date limited efficacy. Acceptance and Commitment Therapy (ACT) has promise to improve behavioral weight loss treatment efficacy by addressing the fundamental challenges of weight loss and maintenance: overeating in response to internal (e.g., stress) and external (e.g., high calorie foods) cues. Here we describe the Weight Loss, Nutrition, and Exercise Study (WeLNES) randomized controlled trial that is testing the efficacy of an ACT-based telehealth coaching intervention for weight loss in comparison to a Standard Behavioral Therapy (SBT)-based telehealth coaching intervention. A total of 398 adults with overweight or obesity are being recruited and randomized to either ACT or SBT telehealth coaching. Participants in both arms are offered twenty-five telehealth coaching sessions in year one and nine booster sessions in year two. All participants receive a Bluetooth-enabled scale to self-monitor weight and a Fitbit Inspire + Fitbit app for tracking diet and physical activity. The primary aim is to determine whether a greater proportion of ACT participants will achieve a clinically significant weight loss of ≥10% compared with SBT participants at 12-months. Secondary outcomes include change in weight from baseline to 6, 12, and 24-months. Whether the effect of ACT on weight loss is mediated by ACT processes and is moderated by baseline factors will also be examined. If ACT proves efficacious, ACT telehealth coaching will offer an effective, broadly scalable weight loss treatment-thereby making a high public health impact.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington, Department of Psychology, Seattle, WA, USA
| | - Kristin E Mull
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Evan M Forman
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, USA
| | - Jason Lillis
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA; College of Psychology, California Northstate University, Elk Grove, CA, USA
| | - Anne McTiernan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington School of Public Health, Department of Epidemiology, USA; University of Washington School of Medicine, Department of Medicine, USA
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Suresh K, Willems E, Williams J, Gritz RM, Dickinson LM, Perreault L, Holtrop JS. An Assessment of Weight Loss Management in Health System Primary Care Practices. J Am Board Fam Med 2023; 36:51-65. [PMID: 36460354 PMCID: PMC10482321 DOI: 10.3122/jabfm.2022.220224r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Primary care practices can help patients address obesity through weight loss; however, there are many barriers to doing so. This study examined weight management services provided and factors associated with higher reported provision of services. METHODS A survey was given to practice members in 18 primary care practices in a Colorado-based health system. The survey assessed weight management services to determine the amount and type of weight loss assistance provided and other factors that may be important. We used descriptive statistics to summarize responses and linear regression with generalized estimating equations to assess the association between the practice and practice member characteristics and the amount of weight management services provided. RESULTS The overall response rate was 64% (254/399). On average, clinicians reported performing 73% of the services, and when grouped into minimal, basic, and extensive, the clinicians on average performed 87%, 68%, and 69% of them, respectively. In a multivariable model adjusted for demographics, factors associated with performing more services included perception of overall better practice culture and perception of weight management implementation climate. CONCLUSIONS Practice-associated factors such as culture and implementation climate may be worth examining to understand how to implement weight management in primary care.
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Affiliation(s)
- Krithika Suresh
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Emileigh Willems
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Johnny Williams
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - R Mark Gritz
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - L Miriam Dickinson
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Leigh Perreault
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
| | - Jodi Summers Holtrop
- From Colorado School of Public Health Department of Biostatistics & Informatics, Aurora (KS, EW); University of Colorado Department of Family Medicine, Aurora (JW, LMD, JSH); University of Colorado Department Medicine-Division of Health Care Policy Research, Aurora (RMG); University of Colorado Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), Aurora (RMG, JSH); University of Colorado Department Medicine-Endocrinology/Metabolism/Diabetes, Aurora (LP)
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Wexler DJ, Chang Y, Levy DE, Porneala B, McCarthy J, Rodriguez Romero A, Goldman V, Copeland PM, Steppel-Reznik J, Delahanty LM. Results of a 2-year lifestyle intervention for type 2 diabetes: the Reach Ahead for Lifestyle and Health-Diabetes randomized controlled trial. Obesity (Silver Spring) 2022; 30:1938-1950. [PMID: 36046939 PMCID: PMC10949180 DOI: 10.1002/oby.23508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/09/2022] [Accepted: 05/14/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The Reach Ahead for Lifestyle and Health (REAL HEALTH)-Diabetes study assessed the comparative effectiveness of two Look AHEAD (Action for Health in Diabetes)-adapted lifestyle intervention (LI) arms targeting weight loss in type 2 diabetes compared with medical nutrition therapy (MNT) referral. At 1 year, LI had greater weight loss than MNT. This study reports outcomes at 24 (end of LI) and 36 months. METHODS Participants (N = 211) with type 2 diabetes and BMI > 25 kg/m2 were randomly assigned to in-person LI, telephone conference call LI, or MNT. The primary outcome was percentage weight change. Secondary outcomes included 5% and 10% weight loss, glycated hemoglobin (HbA1c), and patient-reported outcomes. RESULTS Participants were 61.7 (SD 10.2) years old; 55% were female; 77% were non-Hispanic White; and had mean (SD) weight of 98 (18.9) kg and mean (SD) HbA1c of 7.7% (1.2%). Mean (SD) weight change at 24 and 36 months was -4.4% (5.9%) and -4.4% (5.4%) in in-person LI, -4.0% (5.8%) and -5.3% (6.4%) in telephone LI, and -3.1% (5.2%) and -5.8% (7.1%) in MNT, with no statistically significant difference in weight or HbA1c at 24 and 36 months. Compared with MNT, LI arms had favorable changes in patient-reported outcomes related to learned dietary skills. CONCLUSIONS There were no differences in weight outcomes among LI participants compared with referral to MNT at the end of intervention or 1 year after its conclusion.
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Affiliation(s)
- Deborah J. Wexler
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Yuchiao Chang
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Douglas E. Levy
- Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeanna McCarthy
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Valerie Goldman
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul M. Copeland
- Harvard Medical School, Boston, Massachusetts, USA
- Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mass General Brigham-Salem Hospital, Salem, Massachusetts, USA
| | - Jeanne Steppel-Reznik
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Linda M. Delahanty
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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22
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Street S, Avenell A. Are individual or group interventions more effective for long-term weight loss in adults with obesity? A systematic review. Clin Obes 2022; 12:e12539. [PMID: 35765718 PMCID: PMC9542282 DOI: 10.1111/cob.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 11/15/2022]
Abstract
Guidelines recommend individual and group interventions for weight loss, based on preference. Our 2009 systematic review compared long-term effectiveness of individual or group approaches to the same intervention, but there are new randomized controlled trials (RCTs) of high-quality data. We updated and expanded our previous systematic review. We searched Medline and Embase from 1966 to May 2021, and a clinical trial register from 1966 to 2017. Review Manager (5.4.1) was used to conduct meta-analysis. Ten RCTs were included. The primary outcome, mean weight change at final follow-up, was -1.33 kg (95% confidence interval CI: -2.04, -0.62; 10 trials, 2169 participants), favouring group interventions (p < .001). For the secondary outcomes, attainment of ≥5% body weight loss at final follow-up, the risk ratio (RR) was 1.36 (95% CI 1.05, 1.77; three trials, 1520 participants), favouring group interventions (p = .02); attrition at final follow-up was similar between group and individual arms of trials, RR 0.93 (95% CI 0.82, 1.07) (p = .31). Group interventions can be more effective than individual interventions for long-term weight loss in adults with obesity. However, few studies were included in the clinically relevant, secondary outcome measures. Research on delivering group processes in weight management is needed.
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Affiliation(s)
- Sarah Street
- Health Services Research Unit, Institute of Applied Health SciencesUniversity of AberdeenAberdeenScotland
| | - Alison Avenell
- Health Services Research Unit, Institute of Applied Health SciencesUniversity of AberdeenAberdeenScotland
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Benizri N, Hallot S, Burns K, Goldfarb M. Patient and Family Representation in Randomized Clinical Trials Published in 3 Medical and Surgical Journals: A Systematic Review. JAMA Netw Open 2022; 5:e2230858. [PMID: 36083584 PMCID: PMC9463605 DOI: 10.1001/jamanetworkopen.2022.30858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Patient and family engagement in research may improve the design, conduct, and dissemination of clinical research, but little is known about whether these stakeholder groups are involved in the design and conduct of randomized clinical trials. OBJECTIVE To characterize the involvement and role of patient and family representatives in the design and conduct of randomized clinical trials by reviewing randomized clinical trials from 3 peer-reviewed medical and surgical journals with high impact factors. EVIDENCE REVIEW In this systematic review, the first 50 consecutive randomized clinical trials published on or after January 1, 2021, until September 30, 2021, from each of 3 medical and surgical journals with high impact factors were reviewed for patient or family involvement in trial design and/or conduct. The manuscript, supplemental data, and trial registry records were searched for trial design and governance structures. Two independent, blinded reviewers screened citations and extracted data. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. FINDINGS Only 7 of 150 randomized clinical trials (5%) reported patient or family representation in their study design or conduct. Most studies with patient or family representation (n = 5) were from a single journal. Stakeholder involvement was mainly in the execution phase (n = 7), although in 2 studies stakeholders were also involved in the translation phase. CONCLUSIONS AND RELEVANCE The findings of this systematic review suggest that patient or family involvement in the design and conduct of randomized clinical trials in the publications with high impact factors is lacking. We found that when patient or family groups are involved in research, the focus was mainly on the execution phase of research design. There is a need to increase stakeholder involvement in the research design, conduct, and translation of randomized clinical trials.
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Affiliation(s)
- Nissim Benizri
- Division of Internal Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Sophie Hallot
- McGill Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Karen Burns
- Division of Critical Care Medicine, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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24
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Wadden TA, Gilden AH. Steady progress in the behavioral management of obesity in primary-care settings - but innovation needed. Obesity (Silver Spring) 2022; 30:1535-1536. [PMID: 35894083 DOI: 10.1002/oby.23518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam H Gilden
- Anschutz Health and Wellness Center and Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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25
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Walker R, Ramasamy V, Sturgiss E, Dunbar J, Boyle J. Shared medical appointments for weight loss: a systematic review. Fam Pract 2022; 39:710-724. [PMID: 34536073 DOI: 10.1093/fampra/cmab105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Shared medical appointments (SMAs) may help mitigate some of the barriers for managing obesity in primary care. The primary aim of this systematic review was to measure the effect of weight loss SMAs. METHODS Systematic searches using keywords and Medical Subject Headings for overweight, obesity, and SMAs were conducted in the CENTRAL, Medline Complete, PsycINFO, Scopus, CINAHL, EMBASE, and Web of Science databases with no date limits. Risk of bias was assessed using the Effective Health Practice Project Quality Assessment Tool for Quantitative Studies. RESULTS Fifteen studies involving weight loss SMAs in adults and children were identified. Six studies had controls. Inconsistency in reporting weight loss or weight change in controlled studies meant that data could not be pooled for meta-analysis. Results from individual studies indicated that SMAs can support adult patients to achieve significant weight loss. Women and older adults were more likely to take up SMA invitations. Results from the 5 studies involving children were less conclusive. Studies involving participants of a higher socioeconomic status tended to report lower attrition than studies involving participants who experienced disadvantage. These findings should be interpreted with caution as all but 1 included study was assessed as being weak in quality. CONCLUSIONS Overall, SMAs may be of benefit to address obesity in primary care, particularly for women and older adults. Appropriately designed prospective and controlled studies are required to engage their target audience and to assess whether SMAs are superior to other weight loss options in primary care.
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Affiliation(s)
- Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Vijayanand Ramasamy
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Elizabeth Sturgiss
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Notting Hill, Australia
| | - James Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
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Abstract
This review examines key studies published in 2021 that are related to primary prevention of atherosclerotic cardiovascular disease (ASCVD). Major randomized clinical trials (RCTs) concerning traditional risk factors or ASCVD events, meta‐analyses, and key observational studies related to primary prevention of ASCVD were considered. The review includes interventions for weight loss, cardiometabolic and renal disease, blood pressure control, diet, and the occurrence of cardiovascular disease events. A few studies considered both primary and secondary prevention populations. The review is not exhaustive. We did not include studies that focused on heart failure or clinical presentations that may be difficult to classify, such as acute or chronic ischemic cardiovascular disease without myocardial infarction. Our purpose was to highlight recent research that will help the reader stay abreast of the changing field of cardiovascular prevention.
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Affiliation(s)
- Tamar S Polonsky
- Department of Medicine University of Chicago Medicine Chicago IL
| | - Amit Khera
- Department of Medicine University of Texas, Southwestern Dallas TX
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27
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Kurz D, McCrea-Robertson S, Nelson-Brantley H, Befort C. Rural engagement in primary care for optimizing weight reduction (REPOWER): A mixed methods study of patient perceptions. PATIENT EDUCATION AND COUNSELING 2022; 105:2371-2381. [PMID: 34865892 DOI: 10.1016/j.pec.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/10/2021] [Accepted: 11/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To report on patients' satisfaction and experience of care across three different modes of weight loss counseling. METHODS 1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses. RESULTS 1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight. CONCLUSION Rural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment. PRACTICE IMPLICATIONS Primary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.
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Affiliation(s)
- Daniel Kurz
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA.
| | - Stacy McCrea-Robertson
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA
| | | | - Christie Befort
- University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA
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28
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Comparison of weight loss data collected by research technicians versus electronic medical records: the PROPEL trial. Int J Obes (Lond) 2022; 46:1456-1462. [PMID: 35523955 PMCID: PMC9329211 DOI: 10.1038/s41366-022-01129-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022]
Abstract
Background/Objectives: Pragmatic trials are increasingly used to study the implementation of weight loss interventions in real-world settings. This study compared researcher-measured body weights versus electronic medical record (EMR)-derived body weights from a pragmatic trial conducted in an underserved patient population. Subjects/Methods: The PROPEL trial randomly allocated 18 clinics to usual care (UC) or to an intensive lifestyle intervention (ILI) designed to promote weight loss. Weight was measured by trained technicians at baseline and at 6, 12, 18, and 24 months. A total of 11 clinics (6 UC/5 ILI) with 577 enrolled patients also provided EMR data (n = 561), which included available body weights over the period of the trial. Results: The total number of assessments were 2 638 and 2 048 for the researcher-measured and EMR-derived body weight values, respectively. The correlation between researcher-measured and EMR-derived body weights was 0.988 (n = 1 939; p<0.0001). The mean difference between the EMR and researcher weights (EMR-researcher) was 0.63 (2.65 SD) kg, and a Bland-Altman graph showed good agreement between the two data collection methods; the upper and lower boundaries of the 95% limits of agreement are −4.65 kg and +5.91 kg, and 71 (3.7%) of the values were outside the limits of agreement. However, at 6 months, percent weight loss in the ILI compared to the UC group was 7.3% using researcher-measured data versus 5.5% using EMR-derived data. At 24 months, the weight loss maintenance was 4.6% using the technician-measured data versus 3.5% using EMR-derived data. Conclusion: At the group level, body weight data derived from researcher assessments and an EMR showed good agreement; however, the weight loss difference between ILI and UC was blunted when using EMR data. This suggests that weight loss studies that rely on EMR data may require larger sample sizes to detect significant effects. Clinical trial registration: ClinicalTrials.gov number NCT02561221
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29
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Saint Onge JM, Fagan M, Befort CA. The association between the obesogenic environment and 6-month and 24-month weight change in a rural weight loss intervention trial in the United States. Prev Med 2022; 158:107040. [PMID: 35398370 DOI: 10.1016/j.ypmed.2022.107040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/05/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
The unique obesogenic environment may influence the ability to effectively maintain weight loss in rural areas. The aim of this study was to examine the contextual relationship of neighborhood disadvantage, distance to supermarkets and supercenters, and fast food, dollar store, and exercise facility environments on weight loss following a weight-loss intervention in the United States. This analysis (n = 1177) linked weight loss outcomes from a rural, primary care-based randomized controlled trial to contextual data collected from residential addresses. Outcomes include 6-month and 24-month percent weight loss. These outcomes were compared across contextual variables, including tract level disadvantage, food accessibility, and food/exercise availability. Covariates were included in ordinary least squares (OLS) multivariable regression models for 6-month and 24-month weight loss measures, across three weight loss interventions. Contextual variables were not significantly related to percent weight loss overall across treatment arms. Participants living in a 5-mile buffer to dollar stores experienced approximately a 2% (p < 0.05) lower weight loss, but only in the least effective counseling arm (individual clinic visits), while controlling for both individual and contextual factors. Our results suggest that specific contextual variables in rural populations may play an important role in moderating weight loss outcomes especially under the conditions of less effective interventions.
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Affiliation(s)
- Jarron M Saint Onge
- Department of Sociology, University of Kansas, USA; Department of Population Health, University of Kansas Medical Center, USA.
| | | | - Christie A Befort
- Department of Population Health, University of Kansas Medical Center, USA
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30
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Ross KM, Carpenter CA, Arroyo KM, Shankar MN, Yi F, Qiu P, Anthony L, Ruiz J, Perri MG. Impact of transition from face-to-face to telehealth on behavioral obesity treatment during the COVID-19 pandemic. Obesity (Silver Spring) 2022; 30:858-863. [PMID: 35037410 PMCID: PMC8957501 DOI: 10.1002/oby.23383] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study evaluated whether the transition of a face-to-face behavioral intervention to videoconferencing-based telehealth delivery during the COVID-19 pandemic resulted in significantly smaller weight losses than those typically observed in gold-standard, face-to-face programs. METHODS Participants were 160 adults with obesity (mean [SD] age = 49.2 [11.9] years, BMI = 36.1 [4.2] kg/m2 ) enrolled in two cohorts of a 16-week comprehensive weight-management program. Cohort 1 began in person and transitioned to telehealth (Zoom) delivery during week 11 of the intervention because of COVID-19; Cohort 2 was conducted completely remotely. A noninferiority approach (using a clinically relevant noninferiority margin of 2.5%) was used to assess whether the weight losses observed were inferior to the 8% losses from baseline typically produced by gold-standard, face-to-face lifestyle interventions. RESULTS From baseline to postintervention, participants lost an average of 7.4 [4.9] kg, representing a reduction of 7.2% [4.6%]. This magnitude of weight change was significantly greater than 5.5% (t[159] = 4.7, p < 0.001), and, thus, was within the proposed noninferiority margin. CONCLUSIONS These findings demonstrate that the results of behavioral weight-management interventions are robust, whether delivered in person or remotely, and that individuals can achieve clinically meaningful benefits from behavioral treatment even during a global pandemic. Pragmatic "lessons learned," including modified trial recruitment techniques, are discussed.
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Affiliation(s)
- Kathryn M. Ross
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Chelsea A. Carpenter
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Kelsey M. Arroyo
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Meena N. Shankar
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Fan Yi
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Peihua Qiu
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lisa Anthony
- Department of Computer and Information Science and Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Jaime Ruiz
- Department of Computer and Information Science and Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Michael G. Perri
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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31
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Desouza CV, Johnson-Rabbett BE, Gajewski B, Brown A, Ellerbeck EF, VanWormer JJ, Befort C. The effect of nonpharmaceutical weight-loss interventions in rural patients with diabetes: RE-POWER Diabetes. Obesity (Silver Spring) 2022; 30:884-892. [PMID: 35275606 DOI: 10.1002/oby.23392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/21/2021] [Accepted: 01/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this secondary analysis of the Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER) randomized trial, the authors determined the effectiveness of weight-loss interventions in people with diabetes compared with those without diabetes living in rural areas. METHODS The RE-POWER study was a randomized trial designed to determine the effectiveness of nonpharmacological behavioral weight-loss interventions in rural participants with obesity, comparing the individual in-clinic visit model to in-person group sessions and phone group sessions over 24 months. In this secondary analysis, weight loss was compared in participants with and without diabetes. The effects of factors such as medications, insulin, and behavioral factors were compared. RESULTS Participants with diabetes were less likely to lose weight during the study compared with those without diabetes up to 18 months (4.12% vs. 5.31%; net difference = 1.46%; 95% CI: 0.63%-2.28%). Participants with diabetes on insulin lost less weight than patients with diabetes not on insulin at 6 months (4.52% vs. 6.88%; net difference = 2.35%; 95% CI: 0.55%-4.16%). The group with diabetes had significantly lower changes in blood pressure and lipid parameters versus the group without diabetes. CONCLUSIONS Patients with diabetes in rural areas were less likely to lose weight, and metabolic parameters were less responsive to weight loss, compared with patients without diabetes.
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Affiliation(s)
- Cyrus V Desouza
- Omaha Veterans Affairs Medical Center, Omaha, Nebraska, USA
- Division of Endocrinology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexandra Brown
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeffrey J VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Christie Befort
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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32
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Kurz D, Befort C. Travel burden in a rural primary care behavioral weight loss randomized trial: Impact on visit attendance and weight loss. J Rural Health 2022; 38:980-985. [DOI: 10.1111/jrh.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel Kurz
- Department of Population Health University of Kansas School of Medicine Kansas City Kansas USA
| | - Christie Befort
- Department of Population Health University of Kansas School of Medicine Kansas City Kansas USA
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33
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Tang F, Befort CA, Wick J, Gajewski BJ. Unifying the analysis of continuous and categorical measures of weight loss and incorporating group effect: a secondary re-analysis of a large cluster randomized clinical trial using Bayesian approach. BMC Med Res Methodol 2022; 22:28. [PMID: 35081912 PMCID: PMC8790853 DOI: 10.1186/s12874-021-01499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although frequentist paradigm has been the predominant approach to clinical studies for decades, some limitations associated with the frequentist null hypothesis significance testing have been recognized. Bayesian approaches can provide additional insights into data interpretation and inference by deriving posterior distributions of model parameters reflecting the clinical interest. In this article, we sought to demonstrate how Bayesian approaches can improve the data interpretation by reanalyzing the Rural Engagement in Primary Care for Optimizing Weight Reduction (REPOWER). Methods REPOWER is a cluster randomized clinical trial comparing three care delivery models: in-clinic individual visits, in-clinic group visits, and phone-based group visits. The primary endpoint was weight loss at 24 months and the secondary endpoints included the proportions of achieving 5 and 10% weight loss at 24 months. We reanalyzed the data using a three-level Bayesian hierarchical model. The posterior distributions of weight loss at 24 months for each arm were obtained using Hamiltonian Monte Carlo. We then estimated the probability of having a higher weight loss and the probability of having greater proportion achieving 5 and 10% weight loss between groups. Additionally, a four-level hierarchical model was used to assess the partially nested intervention group effect which was not investigated in the original REPOWER analyses. Results The Bayesian analyses estimated 99.5% probability that in-clinic group visits, compared with in-clinic individual visits, resulted in a higher percent weight loss (posterior mean difference: 1.8%[95% CrI: 0.5,3.2%]), a greater probability of achieving 5% threshold (posterior mean difference: 9.2% [95% CrI: 2.4, 16.0%]) and 10% threshold (posterior mean difference: 6.6% [95% CrI: 1.7, 11.5%]). The phone-based group visits had similar result. We also concluded that including intervention group did not impact model fit significantly. Conclusions We unified the analyses of continuous (the primary endpoint) and categorical measures (the secondary endpoints) of weight loss with one single Bayesian hierarchical model. This approach gained statistical power for the dichotomized endpoints by leveraging the information in the continuous data. Furthermore, the Bayesian analysis enabled additional insights into data interpretation and inference by providing posterior distributions for parameters of interest and posterior probabilities of different hypotheses that were not available with the frequentist approach. Trial registration ClinicalTrials.gov Identifier NCT02456636; date of registry: May 28, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01499-0.
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Affiliation(s)
- Fengming Tang
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA. .,Saint Luke's Health System, Kansas City, MO, 64111, USA.
| | - Christie A Befort
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Jo Wick
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Byron J Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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34
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Appelhans BM, French SA, Martin MA, Lui K, Janssen I. Attenuated efficacy of pediatric obesity treatment during the COVID-19 pandemic. Obesity (Silver Spring) 2022; 30:45-49. [PMID: 34739182 PMCID: PMC8661682 DOI: 10.1002/oby.23313] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study examined whether the efficacy of a standard-of-care pediatric obesity treatment was affected by the COVID-19 pandemic. METHODS Analyses leveraged data from an ongoing pediatric obesity treatment trial involving 230 lower-income, urban children aged 6 to 12 years. Mixed-effects regression models compared children who participated in a 12-month weight-management intervention before versus during the COVID-19 pandemic on change from baseline in BMI z score (ΔzBMI) at 3, 6, 9, and 12 months. RESULTS The observed pattern of ΔzBMI was significantly different before versus during the pandemic (χ2 = 22.73, p < 0.0001). Children treated before the pandemic maintained an average weight loss of -0.06 ΔzBMI at 12 months, whereas children treated during the pandemic steadily gained weight over time, averaging a net gain of 0.11 ΔzBMI at 12 months (χ2 = 34.99, p < 0.0001). Treatment session completion did not differ before versus during the pandemic (60.4% vs. 55.7%, respectively; p = 0.30) or account for differences in ΔzBMI. CONCLUSIONS Similar reductions in intervention efficacy may be anticipated in other pediatric obesity treatment trials conducted during the COVID-19 pandemic. Many families that have struggled with managing their child's weight during this period may need encouragement to continue engaging in structured weight management as society renormalizes.
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Affiliation(s)
- Bradley M. Appelhans
- Department of Preventive MedicineRush University Medical CenterChicagoIllinoisUSA
- Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
| | - Simone A. French
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Molly A. Martin
- Department of PediatricsUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Karen Lui
- Department of PediatricsRush University Medical CenterChicagoIllinoisUSA
| | - Imke Janssen
- Department of Preventive MedicineRush University Medical CenterChicagoIllinoisUSA
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Katzmarzyk PT, Apolzan JW, Gajewski B, Johnson WD, Martin CK, Newton RL, Perri MG, VanWormer JJ, Befort CA. Weight loss in primary care: A pooled analysis of two pragmatic cluster-randomized trials. Obesity (Silver Spring) 2021; 29:2044-2054. [PMID: 34714976 PMCID: PMC9520994 DOI: 10.1002/oby.23292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study was to report the results of five weight-loss interventions in primary care settings in underserved patients and to compare the level of pragmatism across the interventions using the Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2) tool. METHODS Data from 54 primary care clinics (2,210 patients) were pooled from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) and Rural Engagement in Primary Care for Optimizing Weight Reduction (REPOWER) cluster-randomized trials. Clinics were randomized to one of five comparators: PROPEL usual care, PROPEL combination of in-clinic and telephone visits, REPOWER in-clinic individual visits, REPOWER in-clinic group visits, or REPOWER telephone group visits. RESULTS At 24 months, weight loss (kilograms) was -0.50 (95% CI: -1.77 to 0.76), -3.05 (-4.10 to -2.01), -4.30 (-5.35 to -3.26), -4.79 (-5.83 to -3.75), and -4.80 (-5.96 to -3.64) in the PROPEL usual care, REPOWER in-clinic individual visits, REPOWER telephone group visits, REPOWER in-clinic group visits, and PROPEL in-clinic and telephone visits arms, respectively. At 24 months, percentage of weight loss was -0.360 (-1.60 to 0.88), -3.00 (-4.02 to -1.98), -4.23 (-5.25 to -3.20), -4.67 (-5.69 to -3.65), and -4.69 (-5.82 to -3.56), respectively, in the five arms. The REPOWER in-clinic individual visits intervention was the most pragmatic and reflects the current Centers for Medicare and Medicaid Services funding model, although this intervention produced the least weight loss. CONCLUSIONS Clinically significant weight loss over 6 months in primary care settings is achievable using a variety of lifestyle-based treatment approaches. Longer-term weight-loss maintenance is more difficult to achieve.
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Affiliation(s)
| | - John W. Apolzan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Byron Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Corby K. Martin
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert L. Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Michael G. Perri
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Jeffrey J. VanWormer
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Christie A. Befort
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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Affective disorders, weight change, and patient engagement in a rural behavioral weight loss trial. Prev Med 2021; 152:106698. [PMID: 34175347 DOI: 10.1016/j.ypmed.2021.106698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/21/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adults in rural areas have a higher prevalence of obesity and some mental health conditions. The degree to which mental health influences weight loss among rural residents remains unclear. This study evaluated changes in body weight, physical activity, diet, and program engagement outcomes in a cohort of participants with vs. without an affective disorder in a behavioral weight loss trial. METHODS A sample of 1407 adults with obesity were recruited from rural U.S. primary care practices to participate in a weight loss trial. In this secondary analysis, participants were stratified by those with vs. without an affective disorder at baseline. Mixed models were used to estimate changes in outcomes over 24 months. RESULTS One-third of participants (n = 468) had an affective disorder. After covariate adjustment, both groups experienced significant weight loss over 24 months, but weight loss was significantly less among those with an affective disorder at all follow-up times (all p's < 0.001; 24-month weight loss -2.7 ± 0.4 vs. -4.8 ± 0.3 kg). Compared to those without an affective disorder, participants with an affective disorder also had significantly less improvement in physical activity and fruit/vegetable consumption, lower attendance at weight loss sessions, and less engagement in setting weight loss goals and strategies. CONCLUSION Participants with an affective disorder lost less body weight and less improvement in lifestyle measures over 24 months. These trends paralleled reduced engagement in critical intervention activities such as weight loss session attendance. Future interventions should consider additional methods to minimize disengagement in adults with underlying affective disorders.
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Saldivar P, Mira V, Duran P, Moldovan C, Ang G, Parikh N, Lee ML, Friedman TC. Implementing texting programs in the P.O.W.E.R. (preventing obesity with eating right) medical group visit for weight loss. Obes Sci Pract 2021; 7:583-590. [PMID: 34631136 PMCID: PMC8488446 DOI: 10.1002/osp4.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The effect of incorporating mobile technology to support participants' lifestyle change and weight loss in medical group visits has not been well studied in a safety-net setting. RATIONALE AND DESIGN Thus, the rationale of the current study was to examine the effect of text messaging in a medical group visit, and test the effect of two texting programs (12 weeks and 20 weeks), compared to those who did not receive text-messaging in the Preventing Obesity With Eating Right (POWER) group visit program. The primary outcome was weight loss. RESULTS We found that those enrolled in the 20-week and 12-week texting programs attended more group visit sessions than those enrolled in the POWER group only (p < 0.001). Both POWER and POWER + 20-week texting groups had a significant reduction in weight at their final group visit compared to their baseline (POWER, 114 ± 27 kg vs. 112 ± 26 kg, p < 0.001; POWER + 20-week texting, 111 ± 28 kg vs. 109 ± 28 kg, p < 0.01), but not the 12-week texting group (114 ± 29 kg vs. 113 ± 29 kg, p = 0.22), with no differences between the groups. The number of group visits was correlated with a decrease in weight (rs = 0.12, p < 0.05). CONCLUSION In conclusion, text messaging programs led to more attendance in the medical group visits, but not greater weight loss or reduction in HbA1c than the POWER group obesity program alone. Further studies are needed to maximize the beneficial effects of texting programs in medical group visits in underserved minority populations.
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Affiliation(s)
- Perla Saldivar
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Valerie Mira
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Petra Duran
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Christina Moldovan
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Georgina Ang
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | | | - Martin L. Lee
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Theodore C. Friedman
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
- Martin Luther King Jr. Outpatient CenterLos AngelesCaliforniaUSA
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Coelho C, Crane J, Agius R, McGowan B. The Bariatric-Metabolic Physician's Role in Managing Clinically Severe Obesity. Curr Obes Rep 2021; 10:263-273. [PMID: 33964008 PMCID: PMC8106360 DOI: 10.1007/s13679-021-00435-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to outline the obesity physician's role in managing patients with severe obesity with a particular emphasis on bariatric surgery candidates. RECENT FINDINGS Obesity is a chronic, relapsing and progressive disease. Scoring systems that evaluate the severity of obesity based on the clinical assessment, rather than the Body Mass Index, are a valuable tool. The clinical assessment should explore the underlying contributors for weight gain and screen for obesity-related complications. Bariatric surgery remains the most effective management approach for severe and complex obesity. Nevertheless, pharmacotherapy and other non-surgical approaches play an important role. The bariatric-metabolic physician's role is paramount in delivering effective care to patients with obesity. The multiple complications of patients with clinically severe obesity highlight the complexity of their management and reinforce the need for adequate assessment and long-term follow-up to ensure optimal clinical outcomes.
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Affiliation(s)
- Claudia Coelho
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Crane
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rachel Agius
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta
| | - Barbara McGowan
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- Diabetes and Nutritional Sciences, King's College London, London, UK.
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Bruce JM, Cozart JS, Shook RP, Ruppen S, Siengsukon C, Simon S, Befort C, Lynch S, Mahmoud R, Drees B, Norouzinia AN, Bradish T, Posson P, Hibbing PR, Bruce AS. Modifying Diet and Exercise in MS (MoDEMS): Study design and protocol for a telehealth weight loss intervention for adults with obesity & Multiple Sclerosis. Contemp Clin Trials 2021; 107:106495. [PMID: 34216814 DOI: 10.1016/j.cct.2021.106495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
Weight loss improves overall health, and reduces inflammation, risk of stroke, heart attack, diabetes, certain cancers, and death among individuals with obesity. Weight loss also improves mobility, increases stamina, and elevates mood. Between 25 and 33% of people with Multiple Sclerosis (pwMS) have obesity. Multiple Sclerosis (MS) and obesity are independently associated with reduced mobility, increased fatigue, and depression. Most behavioral weight loss trials exclude individuals with neurologic disease. Consequently, few studies have examined the effects of weight loss on symptom presentation and health outcomes among pwMS and obesity. This is the first study examining the efficacy of a comprehensive behavioral weight loss intervention designed specifically for pwMS. The purpose of this study is to develop and assess the efficacy of a telehealth administered weight loss intervention tailored for pwMS. Additionally, we aim to determine if weight loss reduces physical and emotional symptoms in individuals with obesity and MS. We will enroll 70 pwMS in a wait-list crossover trial to examine the efficacy of our intervention. If successful, findings will help determine whether we can help participants lose clinically significant weight - and whether weight loss among pwMS and overweight/obesity reduces fatigue, and improves mobility, mood, and quality of life.
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Affiliation(s)
- Jared M Bruce
- Department of Biomedical and Health Informatics, University of Missouri- Kansas City School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Julia S Cozart
- Department of Biomedical and Health Informatics, University of Missouri- Kansas City School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Robin P Shook
- Center for Healthy Lifestyle and Nutrition, Children's Mercy Hospitals, Kansas City, MO, USA
| | - Stephanie Ruppen
- Department of Biomedical and Health Informatics, University of Missouri- Kansas City School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Catherine Siengsukon
- Department of Physical Therapy and Rehab Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Steve Simon
- Department of Biomedical and Health Informatics, University of Missouri- Kansas City School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Christie Befort
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sharon Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rola Mahmoud
- Department of Neurology, Saint Luke's Hospital, Kansas City, MO, USA
| | - Betty Drees
- Department of Biomedical and Health Informatics, University of Missouri- Kansas City School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA; Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Taylor Bradish
- Department of Biomedical and Health Informatics, University of Missouri- Kansas City School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Paige Posson
- Center for Healthy Lifestyle and Nutrition, Children's Mercy Hospitals, Kansas City, MO, USA
| | - Paul R Hibbing
- Center for Healthy Lifestyle and Nutrition, Children's Mercy Hospitals, Kansas City, MO, USA
| | - Amanda S Bruce
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
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Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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