Overweight and obese men's experiences in a sport-based weight loss intervention for men

Designing Gender-Responsive Health Promotion Programs for Men: A Scoping Review

Over the past decade, there has been an increased emphasis on tailoring men's health promotion programs. To optimize outcomes, participatory action research that involves and elicits feedback from end-users has been highlighted as important to creating gender-responsive interventions. In this scoping review, we examine (a) how participatory action research has been used to design health promotion interventions for men and (b) what constitutes a gender-responsive intervention design. Following a comprehensive search, 53 articles were included in the review, reporting on 35 men's health promotion programs. Our findings suggest that participatory action methods harness varying degrees of end-user involvement, with a large majority limited to post-intervention evaluations rather than co-design and consumer collaboration. In addition, there are inconsistencies for applying gender-responsive approaches within programs, particularly regarding how interventions are targeted, tailored, and promoted to men. We conclude that participatory action research methods translate to varying degrees of gender responsiveness in men's health promotion programs. That said, involving end-users at various stages of intervention design, implementation, and evaluation may increase the likelihood that programs are more attuned to masculinities and better engage participants in promoting healthy behavior change. Efforts to advance gender-responsive designs can benefit from inductively deriving and incorporating men's masculine values.

Accountability Frameworks in Medical Weight Loss Programs: A Comprehensive Literature Review

Limited adherence to weight loss regimens is a major contributor to the unsuccessful treatment of obesity in patients. Accountability approaches have been used to enhance weight loss program adherence. The purpose of our review is to characterize techniques used to improve patient accountability during weight loss programs. The PubMed database was used to search for studies, analyses, and clinical trials that improved adherence by promoting participant accountability. Articles cited by these references were analyzed, yielding 10 studies. The results were evaluated by comparing efficacy in weight loss, accountability measures used, and the value placed by participants on the program's focus on accountability measures. Interventions that required social and professional support, planning, physical activity, and an accountability advisor to follow up beyond self-motivation increased the adherence rates of patients. Tools such as online forums and team-based accountability sessions also promoted adherence to long-term weight loss goals. Treatment programs with multiple interventions are optimal when beginning a long-term treatment plan. These accountability strategies may be used in other areas of medicine.

Promoting men's health through sports clubs: A systematic rapid realist review

BACKGROUND

Health promotion (HP) interventions delivered through sports clubs have demonstrated promising outcomes among men, but less is known about which aspects of the interventions work, for whom, and under what circumstances. This rapid realist review aimed to understand the contexts, mechanisms, and outcomes of HP interventions for men delivered through sports clubs.

METHODS

A systematic literature search was conducted in February 2023 for studies published after 2013 in MEDLINE, Embase, and SPORTDiscus databases.

INCLUDED STUDIES

(a) were delivered by or in collaboration with sports clubs, (b) targeted men aged 18+ years, and (c) reported 1 or more HP outcomes. A grey literature search was also performed. Studies were included in a realist synthesis based on richness and rigor. Hereafter, context-mechanism-outcome (CMO) configurations were developed.

RESULTS

We identified and screened 3358 studies, finally including 59 studies describing 22 interventions. Most HP interventions were delivered in high income countries, included Caucasian men aged 35-65 years with overweight/obesity, and used professional sports clubs (mostly football) for recruitment and facilities. Quantitative HP outcomes were reported across 19 interventions. Of these 19 interventions, the majority reported on weight (n = 18), physical activity (n = 12), mental health (n = 10), and diet (n = 9). We identified 13 CMOs related to how HP interventions affected men's recruitment, engagement, and health behavior maintenance.

CONCLUSION

Our findings show that using sports clubs for HP interventions is effective for engaging men. Recruitment was facilitated by leveraging sports clubs' identity, addressing masculinity-related barriers, improving accessibility, and building trust. Engagement was enhanced through shared identity experiences, safe spaces, inclusive competition, and self-efficacy. However, there's limited evidence on behavior maintenance post-intervention, though involving community stakeholders seemed vital. In general, considerations should be made to avoid perpetuating traditional masculine norms, which may exclude some men and reinforce unhealthy behaviors. These findings can guide intervention development, emphasizing the need to harness men's perspectives in the process.

Gender-sensitive community weight-loss programmes to address overweight and obesity in men: a scoping review

OBJECTIVES

To examine how gender-sensitive community weight-loss programmes have been used to address overweight and obesity in men and to identify what can be learnt from this rapidly evolving field.

DESIGN

Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist for reporting.

DATA SOURCES

A database search was conducted using EBSCOhost (Academic Search Complete, CINAHL Complete, Global Health, Health Source: Consumer Edition, Health Source: Nursing/Academic Edition and Medline Complete), Google, Google Scholar, Open Access Theses and Dissertations platform and Scopus.

ELIGIBILITY CRITERIA

All weight-loss programmes using a gender-sensitive approach to address men's overweight and obesity in community settings.

DATA EXTRACTION AND SYNTHESIS

Narrative synthesis was conducted based on the research questions and objectives. Primary outcomes include operationalisation, context and concept of the gender-sensitive approach. Information was reviewed and extracted to Microsoft Excel by two reviewers.

RESULTS

A total of 40 studies (28 quantitative, eight mixed methods and four qualitative) were identified from 4617 records. Gender-sensitive approaches were undertaken in a range of settings and contexts including professional sports clubs (n=21), non-professional sporting clubs (n=16), workplace-based (n=2) and commercial organisation-based (n=1). The most common analysis approaches were evaluating the effect of the programmes (n=31) where positive impact was predominantly shown (eg, up to 3.9 kg weight reduction at 3-month follow-up). Programmes (ie, Football Fans in Training) were short-term cost-effective (eg, the cost was £862-£2228 per 5% weight reduction at 12-month follow-up). Qualitative evidence highlights factors that influenced men's participation (eg, camaraderie) and identifies areas for improvement.

CONCLUSION

The findings demonstrate that gender-sensitive programmes for men's weight loss have been effectively applied using a range of different approaches and in a range of different contexts. Further evidence is needed to confirm the effectiveness of the programmes across diverse groups of men.

'It's been a lifelong thing for me': parents' experiences of facilitating a healthy lifestyle for their children with severe obesity

OBJECTIVE

For parents and guardians, assisting children/adolescents with severe obesity to lose weight is often a key objective but a complex and difficult challenge. Our aim in this study was to explore parents' (and guardians') perspectives on the challenges they have faced in assisting their children/adolescents with severe obesity to lead a healthy lifestyle.

METHODS

Thirteen parents/guardians were interviewed from a pool of families who had been referred but did not engage between 2016 and 2018 (N = 103), with the Perth Children's Hospital Healthy Weight Service, a clinical obesity program for children/adolescents (parent age M = 43.2 years, children age M = 10.3 years). Using semi-structured interviews and thematic analysis, we identified 3 broad themes.

RESULTS

Parental weight-related factors reflected parents' own lifelong obesity narrative and its effect on their own and their families' ability to live a healthy lifestyle. Perceived inevitability of obesity in their child reflected parents' feelings that the obesity weight status of their children/adolescent was a persistent and overwhelming problem that felt 'out of control'. Lastly, parents reported challenges getting medical help stemming from co-morbid medical diagnosis in their child/adolescent, and difficulties with medical professionals.

CONCLUSION

This study demonstrates that parents face challenges in supporting healthy lifestyle for children/adolescents with severe obesity due to parents own internal weight biases and their negative experiences within the healthcare system when seeking help.

Structured exercise programs for higher education students experiencing mental health challenges: background, significance, and implementation

The incidence of mental illness is greatest among young adults, and those enrolled in higher education may be particularly vulnerable compared to the general young adult population. Many higher education institutions employ student support staff tasked with implementing strategies to improve student wellbeing and mental illness. However, these strategies tend to be focused on clinical therapies and pharmacological interventions with limited lifestyle approaches. Exercise is an effective method for addressing mental illness and promoting wellbeing, yet widespread provision of structured exercise services to support treatment options for students with mental health challenges has not been fully realized. In an effort to guide exercise strategies for student mental health, we synthesize considerations for developing and delivering exercise programs in higher education settings. We draw directly from the evidence base on existing exercise programs in higher education; and the broader behavior change, exercise adherence, health psychology, implementation science, and exercise prescription literatures. Our broad considerations cover issues regarding program engagement and behavior change, exercise 'dose' and prescription, integration with other on-campus services, and robust research and evaluation. These considerations may provide impetus for widespread program development and implementation, as well as informing research focused on protecting and improving student mental health.

Attributes of Expert Anticipation Should Inform the Design of Virtual Reality Simulators to Accelerate Learning and Transfer of Skill

Expert sport performers cope with a multitude of visual information to achieve precise skill goals under time stress and pressure. For example, a major league baseball or cricket batter must read opponent variations in actions and ball flight paths to strike the ball in less than a second. Crowded playing schedules and training load restrictions to minimise injury have limited opportunity for field-based practice in sports. As a result, many sports organisations are exploring the use of virtual reality (VR) simulators. Whilst VR synthetic experiences can allow greater control of visual stimuli, immersion to create presence in an environment, and interaction with stimuli, compared to traditional video simulation, the underpinning mechanisms of how experts use visual information for anticipation have not been properly incorporated into its content design. In themes, this opinion article briefly explains the mechanisms underpinning expert visual anticipation, as well as its learning and transfer, with a view that this knowledge can better inform VR simulator content design. In each theme, examples are discussed for improved content design of VR simulators taking into consideration its advantages and limitations relative to video simulation techniques. Whilst sport is used as the exemplar, the points discussed have implications for skill learning in other domains, such as military and law enforcement. It is hoped that our paper will stimulate improved content design of VR simulators for future research and skill enhancement across several domains.

MAN v FAT Soccer: Feasibility Study and Preliminary Efficacy of a Sport-Based Weight-Loss Intervention for Overweight and Obese Men in Australia

MAN v FAT Soccer is a sport-based weight-loss program for overweight and obese men that originated in the United Kingdom (i.e., as MAN v FAT Football) and appears to successfully engage men with weight loss. We sought to explore whether the program would work in an Australian context by (a) establishing a foundation for the implementation of the program on a larger scale and (b) determining how large-scale implementation is most feasible. We conducted a nonrandomized, single intervention group feasibility trial of MAN v FAT Soccer in Australia with 418 male participants with a body mass index greater than 27.50 kg/m2. Results indicate that the program is acceptable, with participants reporting positive perceptions of the various components of the program and a high proportion reporting intentions to recommend the program to others (95.9%). Furthermore, preliminary effectiveness results indicate positive changes in weight (4.6% reduction) and physical activity (88.5% increase) and improvements in psychological outcomes such as depression (17.6% decrease), stress (19.0% decrease), and body appreciation (19.1% increase). Our findings provide general support for the feasibility of MAN v FAT Soccer and the notion that leveraging competition and masculinity may help drive men's health behavior change.

Perceptions of a family-based lifestyle intervention for children with overweight and obesity: a qualitative study on sustainability, self-regulation, and program optimization

BACKGROUND

Family-based lifestyle interventions (FBLIs) are an important method for treating childhood weight problems. Despite being recognized as an effective intervention method, the optimal structure of these interventions for children's overweight and obesity has yet to be determined. Our aim was to better understand participants' (a) implementation of behaviour strategies and long-term outcomes, (b) perceptions regarding the optimal structure of FBLIs, and (c) insights into psychological concepts that may explain the success of these programs.

METHODS

Purposive sampling was used to recruit participants. We conducted focus groups as well as one-to-one interviews with parents (n = 53) and children (n = 50; aged 7-13, M = 9.4 yr, SD = 3.1) three months following their involvement in a 10-week, multi-component, FBLI involving education and activities relating to healthy nutrition, physical activity, and behavior modification. Using an interpretivist approach, a qualitative study design was employed to examine participant experiences.

RESULTS

We identified three higher-order categories: (a) participants' program experiences and perceptions (b) lifestyle changes post-program, and (c) recommendations for optimizing family-based programs. Themes identified within these categories included (a) support and structure & content, (b) diet and physical activity, and (c) in-program recommendations and post-program recommendations.

CONCLUSIONS

We identified several challenges that can impair lasting behavior change (e.g., physical activity participation) following involvement in a FBLI. On optimizing these programs, participants emphasized fun, interactive content, interpersonal support, appropriate educational content, and behavior change techniques. Concepts rooted in motivational theory could help address calls for greater theoretical and mechanistic insight in FBLIs. Findings may support research advancement and assist health professionals to more consistently realize the potential of these interventions.

The Aussie-FIT process evaluation: feasibility and acceptability of a weight loss intervention for men, delivered in Australian Football League settings

OBJECTIVE

This process evaluation aimed to evaluate the feasibility and acceptability of Aussie-FIT, a group-based weight loss intervention for men with overweight and obesity in Australia.

DESIGN

Process data and data collected from: (1) six-participant focus groups (n= 24), (2) coach interviews (n = 4), (3) audio recordings of Aussie-FIT sessions and (4) post-program participant surveys (n= 93) were analysed.

MAIN OUTCOME MEASURES

We explored the feasibility and acceptability of program setting and context, recruitment strategies, factors impacting implementation and mechanisms of impact.

RESULTS

Recruitment via Australian Football League (AFL) clubs was highly effective; 426 men expressed interest within 3 days of advertising, 130 men took part. Program attendance was not consistently recorded by coaches. Coach interviews indicated a 'core group of men' participated in each session (typically 10-12 of 15 men). Program delivery proved feasible in the AFL context. Program acceptability and satisfaction were high. Internalisation of autonomous motives was identified as driving behaviour change. Behaviour change to support maintained weight loss was facilitated through habit formation, goal setting and effective management of multiple goals.

CONCLUSION

Aussie-FIT sets a blueprint for future weight loss interventions that utilise behaviour change strategies and principles of self-determined motivation to support men to lose weight.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12617000515392.

© 2021 Informa UK Limited, trading as Taylor & Francis Group.

Effectiveness of Adult Health Promotion Interventions Delivered Through Professional Sport: Systematic Review and Meta-Analysis

BACKGROUND

Researchers are capitalising on the strong connections that sport fans have with their teams for health promotion programmes, yet no existing systematic reviews have evaluated the effectiveness of interventions delivered through professional sport.

OBJECTIVE

The aim of this study was to systematically collate, evaluate, and synthesise the evidence on health promotion interventions implemented in professional sport settings.

METHODS

Randomised controlled trials reporting on adult health promotion initiatives delivered in professional sport settings were identified through electronic database searches in CINAHL, MEDLINE, SPORTDiscus, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. Data on health-related outcomes (e.g., weight, physical activity, dietary intake) were extracted and synthesised, and random effects meta-analyses were conducted to examine effects for weight and waist circumference. Risk of bias was examined using the Cochrane risk-of-bias tool for randomised controlled trials (RoB 2).

RESULTS

Six studies reporting on five unique interventions met the inclusion criteria, and all included studies were gender-sensitised and exclusively targeted men. Intervention effects were observed for several health outcomes, including physical activity, dietary intake, and psychosocial health. All studies aimed to reduce weight, and for most studies (n = 4), weight was a primary outcome, either of the included study or to inform a future definitive trial. Findings from the meta-analysis revealed an overall significant difference in change in weight of - 3.2 kg (95% confidence interval [CI] - 4.6 to - 1.8) and waist circumference of - 3.9 cm (95% CI - 4.9 to - 2.8), both in favour of the intervention group at 12 weeks. Intervention effects were also reported for several other health outcomes (e.g., physical activity, dietary intake, psychosocial health); however, they were not consistently measured across the studies and thus were not meta-analysed.

CONCLUSION

Health promotion interventions delivered through professional sporting organisations can significantly improve weight- and lifestyle-related health outcomes. Representation across the socioeconomic spectrum and across culturally and linguistically diverse groups was limited. As only a limited number of studies met the inclusion criteria for this review, a need exists for rigorously designed interventions, standardised intervention approaches, with long-term follow-up, and the potential for scalability.

PROSPERO REGISTRATION NUMBER

CRD42019123295.

Men's Perceptions of a Gender-Tailored eHealth Program Targeting Physical and Mental Health: Qualitative Findings from the SHED-IT Recharge Trial

Despite increasing rates of co-morbid depression and obesity, few interventions target both conditions simultaneously, particularly in men. The SHED-IT: Recharge trial, conducted in 125 men with depressive symptoms and overweight or obesity, tested the efficacy of a gender-tailored eHealth program with integrated mental health support. The aims of this study were to examine the perceptions of men who received the SHED-IT: Recharge intervention in relation to recruitment, satisfaction with the program, and suggestions to improve the program. Individual semi-structured interviews were conducted in a random sub-sample, stratified by baseline depression and weight status (n = 19, mean (SD) age 49.6 years (11.6), PHQ-9 score 9.0 (3.7), BMI 32.5 kg/m2 (4.6)). Transcripts were analyzed using an inductive process by an independent qualitative researcher. Four themes emerged, namely, (i) specific circumstances determined men's motivation to enroll, (ii) unique opportunity to implement sustained physical and mental health changes compared to previous experiences, (iii) salience of the program elements, and (iv) further opportunities that build accountability could help maintain focus. Gender-tailored, self-directed lifestyle interventions incorporating mental health support are acceptable and satisfying for men experiencing depressive symptoms. These findings provide important insights for future self-guided lifestyle interventions for men with poor physical and mental health.

Potential Impacts of Body Image Perception in Female Equestrians

Female body image (BI) has been investigated in many sports yet, in female-dominated equestrianism, there is a paucity of BI research. This study aimed to identify self-perceptions of BI, rider perceptions of judge and coach bias, relationships between BI and self-consciousness and effect of breast size. A four-part, 27 question survey (GoogleForms) was completed by female equestrians (n = 493). The second smallest BI was considered ideal for equestrianism (χ² = 352.751, P < .001) regardless of age, own BI or level of riding commitment. There was a perception judges favor riders with smaller frames (χ² = 54.2111, P < .001) and an association between riders with a larger BI feeling self-conscious when riding (χ² = 87.514, P < .001). More respondents perceived the ideal equestrian BI to be smaller than theirs (Median = -1.5, W = 7777.00, P < .001) and an association between those dissatisfied with their BI and self-consciousness when riding was seen (χ² = 83.649, P < .001). Perception of the ideal equestrian frame is smaller than many riders' own BI, and a larger BI perception negatively impacts self-confidence, potentially hindering performance and participation. Female riders with a larger frame feel they are perceived negatively by judges and further study is indicated to investigate the extent of this potential bias on subjective judging in equestrian disciplines.