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Stubbs RJ, Duarte C, Palmeira AL, Sniehotta FF, Horgan G, Larsen SC, Marques MM, Evans EH, Ermes M, Harjumaa M, Turicchi J, O'Driscoll R, Scott SE, Pearson B, Ramsey L, Mattila E, Matos M, Sacher P, Woodward E, Mikkelsen ML, Sainsbury K, Santos I, Encantado J, Stalker C, Teixeira PJ, Heitmann BL. Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project. Obes Facts 2021; 14:320-333. [PMID: 33915534 PMCID: PMC8255638 DOI: 10.1159/000515663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. The Project: First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. IMPACT The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.
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Affiliation(s)
- R. James Stubbs
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Cristiana Duarte
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - António L. Palmeira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Graham Horgan
- Biomathematics and Statistics Scotland (James Hutton Institute), Aberdeen, United Kingdom
| | - Sofus C. Larsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Marta M. Marques
- Trinity Centre for Practice and Healthcare Innovation and ADAPT Centre, Trinity College Dublin, Dublin, Ireland
| | - Elizabeth H. Evans
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Miikka Ermes
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Jake Turicchi
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Ruari O'Driscoll
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Sarah E. Scott
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Beth Pearson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Lauren Ramsey
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Elina Mattila
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Marcela Matos
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Paul Sacher
- Childhood Nutrition Research Centre, University College London, London, United Kingdom
| | - Euan Woodward
- European Association for the Study of Obesity, Teddington, United Kingdom
| | - Marie-Louise Mikkelsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Kirby Sainsbury
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Inês Santos
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Jorge Encantado
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Carol Stalker
- College of Life and Natural Sciences, University of Derby, Derby, United Kingdom
| | - Pedro J. Teixeira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Scott SE, Duarte C, Encantado J, Evans EH, Harjumaa M, Heitmann BL, Horgan GW, Larsen SC, Marques MM, Mattila E, Matos M, Mikkelsen ML, Palmeira AL, Pearson B, Ramsey L, Sainsbury K, Santos I, Sniehotta F, Stalker C, Teixeira PJ, Stubbs RJ. The NoHoW protocol: a multicentre 2×2 factorial randomised controlled trial investigating an evidence-based digital toolkit for weight loss maintenance in European adults. BMJ Open 2019; 9:e029425. [PMID: 31575569 PMCID: PMC6773359 DOI: 10.1136/bmjopen-2019-029425] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Obesity and associated diseases place a severe burden on healthcare systems. Behavioural interventions for weight loss (WL) are successful in the short term but often result in weight regain over time. Self-regulation of eating and activity behaviours may significantly enhance weight loss maintenance (WLM) and may be effectively augmented by contextual behavioural approaches to emotion regulation. The NoHoW trial tests the efficacy of a theoretically informed, evidence-based digital toolkit using a mobile-enabled website, activity trackers and Wi-Fi scales for WLM aiming to target (1) self-regulation and motivation, and (2) emotion regulation in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial body mass index (BMI) ≥25 kg/m2). METHODS AND ANALYSIS The study is an 18-month, 3-centre, 2×2 factorial single-blind, randomised controlled trial, which recruited 1627 participants achieving ≥5% WL between March 2017 and March 2018. Participants are randomly allocated to one of four arms: (1) self-monitoring only (self-weighing and activity tracker), (2) self-regulation and motivation, (3) emotion regulation or (4) combined self-regulation, motivation and emotion regulation. Participants attend four clinical investigation days at 0, 6, 12 and 18 months and are instructed to use the digital toolkit for 18 weeks during the first 6 months and at their discretion for the remaining 12 months. The primary outcome is change in weight (kg) at 12 months from baseline. Secondary outcomes are body composition (eg, bioimpedance analysis), health biomarkers (glycated haemoglobin, lipids, blood pressure, hair cortisol), dietary intake, physical activity, sleep, motivational, self-regulatory, emotion regulatory moderators/mediators of WLM, engagement, user experience, acceptability and cost-effectiveness of the interventions. ETHICS AND DISSEMINATION Ethical approval was granted by Institutional Ethics Committees at the Universities of Leeds (17-0082; 27 February 2017), Lisbon (17/2016; 20 February 2017) and Capital Region of Denmark (H-16030495, 8 March 2017). Results will be published in scientific journals. TRIAL REGISTRATION NUMBER ISRCTN88405328.
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Affiliation(s)
- Sarah Ellen Scott
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Cristiana Duarte
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Jorge Encantado
- Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Elizabeth H Evans
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Marja Harjumaa
- VTT, VTT Technical Research Centre of Finland, Ltd, Espoo, Finland
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, The Parker Institut, Frederiksberg, The Capital Region, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Sofus C Larsen
- Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, The Parker Institut, Frederiksberg, The Capital Region, Denmark
| | - Marta Moreira Marques
- Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
- Trinity Centre for Practice and Healthcare Innovation & ADAPT Centre, University of Dublin Trinity College, Dublin, UK
| | - Elina Mattila
- VTT, VTT Technical Research Centre of Finland, Ltd, Espoo, Finland
| | - Marcela Matos
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Marie-Louise Mikkelsen
- Research Unit for Dietary Studies, Bispebjerg and Frederiksberg Hospital, The Parker Institut, Frederiksberg, The Capital Region, Denmark
| | | | - Beth Pearson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Lauren Ramsey
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Kirby Sainsbury
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Inês Santos
- Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Falko Sniehotta
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Stalker
- College of Life and Natural Sciences, University of Derby, Derby, UK
| | - P J Teixeira
- Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - R James Stubbs
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Soffin MT, Batsell WR. Towards a situational taxonomy of comfort foods: A retrospective analysis. Appetite 2019; 137:152-162. [DOI: 10.1016/j.appet.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/01/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
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Le TP. The association of conformity to feminine norms with women's food consumption after a negative mood induction. Appetite 2018; 133:123-129. [PMID: 30385264 DOI: 10.1016/j.appet.2018.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/27/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022]
Abstract
The current study examined the relation between women's food intake and their conformity to feminine norms after a negative mood induction, as well as the potential moderating role of expressive suppression. Female participants (N = 197) watched a sad movie clip, partook in a taste test in which they consumed potato chips and chocolate, and completed a survey with questions designed to assess conformity to feminine norms and the use of expressive suppression in daily life. Regression analyses revealed that increased conformity to the feminine norm of modesty was associated with reduced food intake, whereas conformity to the feminine norms of thinness and appearance were not. Expressive suppression did not moderate any of these relations. Overall, this study affirms the importance of understanding how overarching cultural norms such as femininity influence women's food consumption.
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Affiliation(s)
- Thomas P Le
- Department of Psychology, The University of Maryland, College Park, 3280 Biology Psychology Building, College Park, MD, 20740, USA.
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Lu J, Huet C, Dubé L. Emotional reinforcement as a protective factor for healthy eating in home settings. Am J Clin Nutr 2011; 94:254-61. [PMID: 21613564 DOI: 10.3945/ajcn.110.006361] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND According to the literature, meals consumed at home are healthier than those consumed away from home (AFH), but reasons underlying this protective effect have not been fully understood. Emotional reinforcement of healthy eating patterns at home is examined as a putative contributing mechanism. OBJECTIVE This study examined expectations for within-individual emotional reinforcement of healthy eating at home, reflected in reports of 1) more intense positive and less intense negative affects after healthier meals than at baseline at home (and not in AFH settings) and 2) more intense positive and less intense negative affects reported before a meal being predictive of healthier meals than at baseline at home (and not in AFH settings). DESIGN A total of 160 nonobese women reported their eating behavior and momentary emotional states every 2 h, 6 times/d over 10 observation days. We examined observations with meals (breakfast, lunch, or dinner). The participants indicated how momentary eating patterns compared with their own baseline eating patterns (healthier, equal, or less healthy). Concurrent (after meal) and lagged (before meal) emotion scores were specified. RESULTS At-home meals were followed by more intense positive emotions and less worry than were AFH meals. As expected, home meals that were healthier than a person's baseline meals were followed by more intense positive emotions, with a relation of opposite direction being observed in AFH settings. At home, more intense premeal positive emotions cued healthier next-meal eating patterns than did those at baseline, with no such relation being observed in AFH settings. CONCLUSION The home is a privileged environment that nurtures healthy eating and in which healthier food choices trigger and are triggered by more positive emotions.
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Affiliation(s)
- Ji Lu
- Department of Business and Social Sciences, Nova Scotia Agricultural College, Truro, Canada
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Raspopow K, Abizaid A, Matheson K, Anisman H. Psychosocial stressor effects on cortisol and ghrelin in emotional and non-emotional eaters: influence of anger and shame. Horm Behav 2010; 58:677-84. [PMID: 20540943 DOI: 10.1016/j.yhbeh.2010.06.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 06/02/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
Abstract
Food consumption in stressful situations vary as a function of individual difference factors (e.g., emotional vs. non-emotional eating), and may be related to hormonal responses elicited by the stressful event. These hormonal responses may be tied to specific emotions elicited by the stressful event. The present investigation examined the emotional and hormonal (cortisol, ghrelin) responses of high and low emotional eaters following a laboratory stressor (Trier Social Stress Test; TSST). Women (n=48) either high or low in emotional eating status were tested in a TSST or served as controls during which blood samples were taken for analysis of cortisol and ghrelin, both of which have been implicated in eating and in response to stressors. The TSST promoted elevated cortisol levels, being somewhat more pronounced in emotional than in non-emotional eaters. Both shame and anger were provoked by the TSST, and although both these emotions were correlated with cortisol levels, only anger significantly mediated the relationship between the stressor and cortisol levels. As well, baseline ghrelin levels in low emotional eaters exceeded that of high emotional eaters, and increased moderately in response to the stressor situation, irrespective of emotional eating status. Interestingly, when provided with food, ghrelin levels declined in the non-emotional eaters, but not in emotional eaters. The possibility is offered that the lack of a decline of ghrelin in emotional eaters may sustain eating in these individuals.
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Affiliation(s)
- Kate Raspopow
- Institute of Neuroscience, Carleton University, Ottawa, Ontario, Canada
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Feeding Your Feelings: Emotion Regulation Strategies and Emotional Eating. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2010; 36:792-804. [DOI: 10.1177/0146167210371383] [Citation(s) in RCA: 280] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The process by which emotions affect eating behavior emerges as one of the central unresolved questions in the field of emotional eating. The present studies address the hypothesis that the regulation strategies people use to deal with these emotions are responsible for increased eating. Negative emotions were induced and intake of comfort food and non—comfort food was measured by means of taste tests. Emotion induction was preceded by measuring individual differences in emotion regulation strategies (Study 1) or by instructions to regulate emotions in either an adaptive (reappraisal) or maladaptive (suppression) manner (Study 2). Study 3 also entailed a control condition without any regulation instructions. Relative to reappraisal and spontaneous expression, suppression led to increased food intake, but only of the comfort foods. Emotions themselves were not responsible for this effect. These findings provide new evidence that the way in which emotions are regulated affects eating behavior.
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Ciampolini M, Lovell-Smith D, Sifone M. Sustained self-regulation of energy intake. Loss of weight in overweight subjects. Maintenance of weight in normal-weight subjects. Nutr Metab (Lond) 2010; 7:4. [PMID: 20148113 PMCID: PMC2819248 DOI: 10.1186/1743-7075-7-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 01/19/2010] [Indexed: 12/31/2022] Open
Abstract
Background Dietary restraint is largely unsuccessful for controlling obesity. As an alternative, subjects can easily be trained to reliably recognize sensations of initial hunger (IH) a set of physiological sensations which emerge spontaneously, not necessarily at planned mealtimes, and may be the afferent arm of a homeostatic system of food intake regulation. Previously we have reported that IH is associated with blood glucose concentration (BG) below 81.8 mg/dL (4.55 mmol/l), (low blood glucose, LBG), and that a pattern of meals in which IH is present pre-meal (IHMP) improved insulin sensitivity, HbA1c and other cardiovascular risk factors. Here we report the effect upon weight in overweight and normal weight subjects. Objective To investigate whether the IHMP is associated with sustained loss of weight in overweight subjects over a 5 month period. Methods Seventy four overweight subjects (OW: BMI > 25) and 107 normal weight (NW) subjects were randomly allocated to either trained (OW: N = 51; NW N = 79) or control (OW: N = 23; NW: N = 28) groups. All subjects were allocated post-randomization into either low or high mean pre-meal BG groups (LBG and HBG groups) using a demarcation point of 81.8 mg/dL. Results A significant longitudinal decrease was found in body weight (trained NW: -2.5 ± 4.6 kg; OW -6.7 ± 4.5 kg; controls: NW +3.5 ± 4.0 kg and OW -3.4 ± 4.0 kg; P = 0.006 and 0.029) and in energy intake, mean BG, standard deviation of diary BG (BG as recorded by subjects' 7-day diary), BMI, and arm and leg skin-fold thickness in (OW and NW) HBG subjects. OW LBG subjects significantly decreased body weight (trained: -4.0 ± 2.4 kg; controls: -0.4 ± 3.7 kg; P = 0.037). 26 NW LBG subjects showed no longitudinal difference after training as did 9 control subjects. Conclusion Over a 5 month period the IHMP resulted in significant loss of weight in OW subjects compared to controls practicing dietary restraint. NW subjects maintained weight overall, however NW HBG subjects also lost weight compared to controls.
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Affiliation(s)
- Mario Ciampolini
- Unit of Preventive Gastroenterology, Department of Paediatrics, Università di Firenze, 50132 Florence, Italy
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Amiraian DE, Sobal J. Dating and eating. Beliefs about dating foods among university students. Appetite 2009; 53:226-32. [DOI: 10.1016/j.appet.2009.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 06/11/2009] [Accepted: 06/27/2009] [Indexed: 10/20/2022]
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