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Epstein LH, Wilfley DE, Kilanowski C, Quattrin T, Cook SR, Eneli IU, Geller N, Lew D, Wallendorf M, Dore P, Paluch RA, Schechtman KB. Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care: A Randomized Clinical Trial. JAMA 2023; 329:1947-1956. [PMID: 37314275 PMCID: PMC10265310 DOI: 10.1001/jama.2023.8061] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/25/2023] [Indexed: 06/15/2023]
Abstract
Importance Intensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings. Objective To evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings. Design, Setting, and Participants This randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 through August 2021. Interventions Family-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress. Main Outcomes and Measures The primary outcome was the child's change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents. Results Among 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (-6.21% [95% CI, -10.14% to -2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, -2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; -1.05% [95% CI, -3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, -3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings). Conclusions and Relevance Family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families with multiple children. Trial Registration ClinicalTrials.gov Identifier: NCT02873715.
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Affiliation(s)
- Leonard H. Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Steven R. Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Ihuoma U. Eneli
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Daphne Lew
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Michael Wallendorf
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Peter Dore
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Rocco A. Paluch
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Kenneth B. Schechtman
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, Missouri
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Epstein LH, Schechtman KB, Kilanowski C, Ramel M, Moursi NA, Quattrin T, Cook SR, Eneli IU, Pratt C, Geller N, Campo R, Lew D, Wilfley DE. Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study. Contemp Clin Trials 2021; 109:106497. [PMID: 34389519 PMCID: PMC9664376 DOI: 10.1016/j.cct.2021.106497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/20/2021] [Accepted: 06/27/2021] [Indexed: 12/11/2022]
Abstract
Family-based behavioral treatment (FBT) is an evidence-based treatment for pediatric obesity. FBT has primarily been implemented in specialty clinics, with highly trained interventionists. The goal of this study is to assess effectiveness of FBT implemented in pediatric primary care settings using newly trained interventionists who might implement FBT in pediatric practices. The goal is to randomize 528 families with a child with overweight/obesity (≥85th BMI percentile) and parent with overweight/obesity (BMI ≥ 25) across four sites (Buffalo and Rochester, New York; Columbus, Ohio; St. Louis, Missouri) to FBT or usual care and obtain assessments at 6-month intervals over 24 months of treatment. FBT is implemented using a mastery model, which provides quantity of treatment tailored to family progress and following the United States Preventive Services Task Force recommendations for effective dose and duration of treatment. The primary outcome of the trial is change in relative weight for children, and secondarily, for parents and siblings who are overweight/obese. Between group differences in the tendency to prefer small immediate rewards over larger, delayed rewards (delay discounting) and how this is related to treatment outcome is also evaluated. Challenges in translation of group-based interventions to individualized treatments in primary care settings, and in study implementation that arose due to the COVID-19 pandemic are discussed. It is hypothesized that the FBT intervention will be associated with better changes in relative weight for children, parents, and siblings than usual care. The results of this study can inform future dissemination and implementation of FBT into primary care settings.
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Affiliation(s)
- Leonard H Epstein
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Kenneth B Schechtman
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Colleen Kilanowski
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Melissa Ramel
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nasreen A Moursi
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine, and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Steven R Cook
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Ihouma U Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charlotte Pratt
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nancy Geller
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Campo
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Daphne Lew
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Swift DL, McGee JE, Huff AC, Clunan MC, Gniewek NR, Brown TT, Osborne BG, Bucher C, Tanner CJ, Barefoot SG, Brophy P, Clark A, Dubis GS, Martin CK, Beyl RA, Houmard JA, Carels RA, Pories W, Matarese LE. Prescribed exercise to Reduce Recidivism After Weight Loss-Pilot (PREVAIL-P): Design, methods and rationale. Contemp Clin Trials Commun 2021; 21:100717. [PMID: 33553797 PMCID: PMC7848432 DOI: 10.1016/j.conctc.2021.100717] [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: 06/04/2020] [Revised: 10/12/2020] [Accepted: 01/11/2021] [Indexed: 11/20/2022] Open
Abstract
Clinically significant weight loss is associated with health benefits for overweight and obese adults. Participation in adequate amounts of physical activity is critical for weight maintenance. However, the recommended amount of physical activity needed to promote weight maintenance is based primarily on retrospective studies that quantified physical activity levels through questionnaires which tend to overestimate physical activity levels. In addition, the present literature has provided little data on the impact of these physical activity levels on cardiovascular and diabetes risk factors, which may have equal or more clinical importance than weight changes. The Prescribed Exercise to Reduce Recidivism After Weight Loss-Pilot (PREVAIL-P) study will evaluate the effect of aerobic exercise training amount on weight maintenance following clinically significant weight loss in overweight and obese adults (BMI 25-40 kg/m2) age 30-65 years. Participants (N = 39) will complete a 10-week OPTIFAST® weight loss program with supervised aerobic exercise training. Individuals who achieve ≥7% weight loss from baseline will be subsequently randomized to levels of aerobic training consistent with physical activity recommendations (PA-REC) or weight maintenance recommendations (WM-REC) for 18 additional weeks. The primary outcome of the PREVAIL-P study will be change in weight from the completion of OPTIFAST® program to the end of the study. Notable secondary measures include changes in clinically relevant cardiometabolic risk factors between study groups (e.g. blood lipids concentrations, oral glucose tolerance, arterial stiffness). This pilot study will be used to estimate the effect sizes needed for a randomized controlled trial on this topic.
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Affiliation(s)
- Damon L. Swift
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina Univeristy, Greenville, NC, 27858, USA
| | - Joshua E. McGee
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina Univeristy, Greenville, NC, 27858, USA
| | - Anna C. Huff
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina Univeristy, Greenville, NC, 27858, USA
| | - Marie C. Clunan
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina Univeristy, Greenville, NC, 27858, USA
| | - Nicole R. Gniewek
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina Univeristy, Greenville, NC, 27858, USA
| | - Taylor T. Brown
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina Univeristy, Greenville, NC, 27858, USA
| | | | | | - Charles J. Tanner
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina Univeristy, Greenville, NC, 27858, USA
| | - Savanna G. Barefoot
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina Univeristy, Greenville, NC, 27858, USA
| | - Patricia Brophy
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, 27858, USA
| | - Angela Clark
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, 27858, USA
| | - Gabriel S. Dubis
- East Carolina Diabetes and Obesity Institute, East Carolina University, Greenville, NC, 27858, USA
| | - Corby K. Martin
- Ingestive Behavior Laboratory, Pennington Biomedical, Baton Rouge, LA, 70808, USA
| | - Robbie A. Beyl
- Biostatistics & Analysis Laboratory, Pennington Biomedical, Baton Rouge, LA, 70808, USA
| | - Joseph A. Houmard
- Department of Kinesiology, East Carolina University, Greenville, NC, 27858, USA
- Human Performance Laboratory, East Carolina Univeristy, Greenville, NC, 27858, USA
| | - Robert A. Carels
- Department of Psychology, East Carolina University, Greenville, NC, 27858, USA
| | - Walter Pories
- Department of Surgery, East Carolina University, Greenville, NC, 27858, USA
| | - Laura E. Matarese
- Department of Internal Medicine, East Carolina University, Greenville, NC, 27858, USA
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Wang ML, Waring ME, Jake-Schoffman DE, Oleski JL, Michaels Z, Goetz JM, Lemon SC, Ma Y, Pagoto SL. Clinic Versus Online Social Network-Delivered Lifestyle Interventions: Protocol for the Get Social Noninferiority Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e243. [PMID: 29229591 PMCID: PMC5742659 DOI: 10.2196/resprot.8068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/22/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022] Open
Abstract
Background Online social networks may be a promising modality to deliver lifestyle interventions by reducing cost and burden. Although online social networks have been integrated as one component of multimodality lifestyle interventions, no randomized trials to date have compared a lifestyle intervention delivered entirely via online social network with a traditional clinic-delivered intervention. Objective This paper describes the design and methods of a noninferiority randomized controlled trial, testing (1) whether a lifestyle intervention delivered entirely through an online social network would produce weight loss that would not be appreciably worse than that induced by a traditional clinic-based lifestyle intervention among overweight and obese adults and (2) whether the former would do so at a lower cost. Methods Adults with body mass index (BMI) between 27 and 45 kg/m2 (N=328) will be recruited from the communities in central Massachusetts. These overweight or obese adults will be randomized to two conditions: a lifestyle intervention delivered entirely via the online social network Twitter (Get Social condition) and an in-person group-based lifestyle intervention (Traditional condition) among overweight and obese adults. Measures will be obtained at baseline, 6 months, and 12 months after randomization. The primary noninferiority outcome is percentage weight loss at 12 months. Secondary noninferiority outcomes include dietary intake and moderate intensity physical activity at 12 months. Our secondary aim is to compare the conditions on cost. Exploratory outcomes include treatment retention, acceptability, and burden. Finally, we will explore predictors of weight loss in the online social network condition. Results The final wave of data collection is expected to conclude in June 2019. Data analysis will take place in the months following and is expected to be complete in September 2019. Conclusions Findings will extend the literature by revealing whether delivering a lifestyle intervention via an online social network is an effective alternative to the traditional modality of clinic visits, given the former might be more scalable and feasible to implement in settings that cannot support clinic-based models. Trial Registration ClinicalTrials.gov NCT02646618; https://clinicaltrials.gov/ct2/show/NCT02646618 (Archived by WebCite at http://www.webcitation.org/6v20waTFW)
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Affiliation(s)
- Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Molly E Waring
- Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, United States
| | - Danielle E Jake-Schoffman
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jessica L Oleski
- Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, United States
| | - Zachary Michaels
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jared M Goetz
- Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, United States
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Yunsheng Ma
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sherry L Pagoto
- Department of Allied Health Sciences, College of Agriculture, Health, and Natural Resources, University of Connecticut, Storrs, CT, United States
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Ingels JB, Walcott RL, Wilson MG, Corso PS, Padilla HM, Zuercher H, DeJoy DM, Vandenberg RJ. A Prospective Programmatic Cost Analysis of Fuel Your Life: A Worksite Translation of DPP. J Occup Environ Med 2016; 58:1106-1112. [PMID: 27820760 PMCID: PMC5927588 DOI: 10.1097/jom.0000000000000868] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE An accounting of the resources necessary for implementation of efficacious programs is important for economic evaluations and dissemination. METHODS A programmatic costs analysis was conducted prospectively in conjunction with an efficacy trial of Fuel Your Life (FYL), a worksite translation of the Diabetes Prevention Program. FYL was implemented through three different modalities, Group, Phone, and Self-study, using a micro-costing approach from both the employer and societal perspectives. RESULTS The Phone modality was the most costly at $354.6 per participant, compared with $154.6 and $75.5 for the Group and Self-study modalities, respectively. With the inclusion of participant-related costs, the Phone modality was still more expensive than the Group modality but with a smaller incremental difference ($461.4 vs $368.1). CONCLUSIONS This level of cost-related detail for a preventive intervention is rare, and our analysis can aid in the transparency of future economic evaluations.
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Affiliation(s)
- Justin B Ingels
- Economic Evaluation Research Group, College of Public Health (Drs Ingels, Walcott, Corso); Workplace Health Group, College of Public Health (Mr Wilson, Ms Padilla, Drs Zuercher, DeJoy); and Department of Management, Terry College of Business, University of Georgia, Athens, Georgia (Dr Vandenberg)
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Cefalu WT, Buse JB, Tuomilehto J, Fleming GA, Ferrannini E, Gerstein HC, Bennett PH, Ramachandran A, Raz I, Rosenstock J, Kahn SE. Update and Next Steps for Real-World Translation of Interventions for Type 2 Diabetes Prevention: Reflections From a Diabetes Care Editors' Expert Forum. Diabetes Care 2016; 39:1186-201. [PMID: 27631469 PMCID: PMC4915559 DOI: 10.2337/dc16-0873] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The International Diabetes Federation estimates that 415 million adults worldwide now have diabetes and 318 million have impaired glucose tolerance. These numbers are expected to increase to 642 million and 482 million, respectively, by 2040. This burgeoning pandemic places an enormous burden on countries worldwide, particularly resource-poor regions. Numerous landmark trials evaluating both intensive lifestyle modification and pharmacological interventions have persuasively demonstrated that type 2 diabetes can be prevented or its onset can be delayed in high-risk individuals with impaired glucose tolerance. However, key challenges remain, including how to scale up such approaches for widespread translation and implementation, how to select appropriately from various interventions and tailor them for different populations and settings, and how to ensure that preventive interventions yield clinically meaningful, cost-effective outcomes. In June 2015, a Diabetes Care Editors' Expert Forum convened to discuss these issues. This article, an outgrowth of the forum, begins with a summary of seminal prevention trials, followed by a discussion of considerations for selecting appropriate populations for intervention and the clinical implications of the various diagnostic criteria for prediabetes. The authors outline knowledge gaps in need of elucidation and explore a possible new avenue for securing regulatory approval of a prevention-related indication for metformin, as well as specific considerations for future pharmacological interventions to delay the onset of type 2 diabetes. They conclude with descriptions of some innovative, pragmatic translational initiatives already under way around the world.
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Affiliation(s)
- William T. Cefalu
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - John B. Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Dasman Diabetes Institute, Dasman, Kuwait; Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia; and Center for Vascular Prevention, Danube University Krems, Krems, Austria
| | | | | | | | | | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran’s Diabetes Hospitals, Chennai, India
| | - Itamar Raz
- Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City and The University of Texas Southwestern Medical Center, Dallas, TX
| | - Steven E. Kahn
- VA Puget Sound Health Care System and University of Washington, Seattle, WA
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Mudaliar U, Zabetian A, Goodman M, Echouffo-Tcheugui JB, Albright AL, Gregg EW, Ali MK. Cardiometabolic Risk Factor Changes Observed in Diabetes Prevention Programs in US Settings: A Systematic Review and Meta-analysis. PLoS Med 2016; 13:e1002095. [PMID: 27459705 PMCID: PMC4961455 DOI: 10.1371/journal.pmed.1002095] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/17/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The Diabetes Prevention Program (DPP) study showed that weight loss in high-risk adults lowered diabetes incidence and cardiovascular disease risk. No prior analyses have aggregated weight and cardiometabolic risk factor changes observed in studies implementing DPP interventions in nonresearch settings in the United States. METHODS AND FINDINGS In this systematic review and meta-analysis, we pooled data from studies in the United States implementing DPP lifestyle modification programs (focused on modest [5%-7%] weight loss through ≥150 min of moderate physical activity per week and restriction of fat intake) in clinical, community, and online settings. We reported aggregated pre- and post-intervention weight and cardiometabolic risk factor changes (fasting blood glucose [FBG], glycosylated hemoglobin [HbA1c], systolic or diastolic blood pressure [SBP/DBP], total [TC] or HDL-cholesterol). We searched the MEDLINE, EMBASE, Cochrane Library, and Clinicaltrials.gov databases from January 1, 2003, to May 1, 2016. Two reviewers independently evaluated article eligibility and extracted data on study designs, populations enrolled, intervention program characteristics (duration, number of core and maintenance sessions), and outcomes. We used a random effects model to calculate summary estimates for each outcome and associated 95% confidence intervals (CI). To examine sources of heterogeneity, results were stratified according to the presence of maintenance sessions, risk level of participants (prediabetes or other), and intervention delivery personnel (lay or professional). Forty-four studies that enrolled 8,995 participants met eligibility criteria. Participants had an average age of 50.8 years and body mass index (BMI) of 34.8 kg/m2, and 25.2% were male. On average, study follow-up was 9.3 mo (median 12.0) with a range of 1.5 to 36 months; programs offered a mean of 12.6 sessions, with mean participant attendance of 11.0 core sessions. Sixty percent of programs offered some form of post-core maintenance (either email or in person). Mean absolute changes observed were: weight -3.77 kg (95% CI: -4.55; -2.99), HbA1c -0.21% (-0.29; -0.13), FBG -2.40 mg/dL (-3.59; -1.21), SBP -4.29 mmHg (-5.73, -2.84), DBP -2.56 mmHg (-3.40, 1.71), HDL +0.85 mg/dL (-0.10, 1.60), and TC -5.34 mg/dL (-9.72, -0.97). Programs with a maintenance component achieved greater reductions in weight (additional -1.66kg) and FBG (additional -3.14 mg/dl). Findings are subject to incomplete reporting and heterogeneity of studies included, and confounding because most included studies used pre-post study designs. CONCLUSIONS DPP lifestyle modification programs achieved clinically meaningful weight and cardiometabolic health improvements. Together, these data suggest that additional value is gained from these programs, reinforcing that they are likely very cost-effective.
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Affiliation(s)
- Uma Mudaliar
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Azadeh Zabetian
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ann L. Albright
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edward W. Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mohammed K. Ali
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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8
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Yeh MC, Heo M, Suchday S, Wong A, Poon E, Liu G, Wylie-Rosett J. Translation of the Diabetes Prevention Program for diabetes risk reduction in Chinese immigrants in New York City. Diabet Med 2016; 33:547-51. [PMID: 26179569 PMCID: PMC4713381 DOI: 10.1111/dme.12848] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 01/19/2023]
Abstract
AIMS To evaluate the effectiveness and feasibility of implementing a linguistically and culturally tailored Diabetes Prevention Program among Chinese immigrants with prediabetes living in New York City. METHODS A total of 60 Chinese immigrants with prediabetes were randomized into either a Diabetes Prevention Program lifestyle intervention (n = 30) consisting of 12 bi-weekly core sessions and six monthly post-core sessions or the control intervention (n = 30), consisting of quarterly mailing of diabetes prevention information. Each Diabetes Prevention Program intervention session lasted 1.5-2 h and covered topics such as healthy eating, physical activity, stress reduction and problem-solving skills. Outcomes such as percent change in weight, BMI, and HbA1c concentration were assessed at baseline, 6 and 12 months. A mixed-effects linear regression was applied to test the intervention effect at months 6 and 12. Data were collected in the period 2012-2013 and analysed in 2014. RESULTS The participant attrition rate was < 5% (2 out of 60) at 12 months. There was a significantly greater percent weight loss in the intervention group (-3.5 vs. -0.1%; P = 0.0001) at 6 months, which was largely maintained at 12 months (-3.3 vs. 0.3%; P = 0.0003). CONCLUSIONS Participants in a Diabetes Prevention Program-based intervention achieved greater weight loss and improvements in HbA1c concentration than control participants. Evaluation of the Chinese Diabetes Prevention Program curriculum in a larger trial is warranted.
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Affiliation(s)
- M-C Yeh
- Nutrition Program, CUNY School of Public Health, New York, NY, USA
| | - M Heo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - S Suchday
- Department of Psychology, Pace University, New York, NY, USA
| | - A Wong
- Chinese Community Partnership for Health, New York Presbyterian-Lower Manhattan Hospital, New York, NY, USA
| | - E Poon
- Chinese Community Partnership for Health, New York Presbyterian-Lower Manhattan Hospital, New York, NY, USA
| | - G Liu
- Chinese American Independent Practice Association, New York, NY, USA
| | - J Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
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Marrero DG, Palmer KNB, Phillips EO, Miller-Kovach K, Foster GD, Saha CK. Comparison of Commercial and Self-Initiated Weight Loss Programs in People With Prediabetes: A Randomized Control Trial. Am J Public Health 2016; 106:949-56. [PMID: 26890171 DOI: 10.2105/ajph.2015.303035] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine if a widely available weight-management program (Weight Watchers) could achieve sufficient weight loss in persons with prediabetes compared with a Diabetes Prevention Program-based individual counseling program supported by National Diabetes Education Program materials. METHODS We conducted an individual, randomized intervention trial in Indianapolis, Indiana, in 2013 to 2014, in 225 persons with prediabetes. We compared the Weight Watchers weight-management program (n = 112) with Your Game Plan to Prevent Type 2 Diabetes, a program developed by the National Diabetes Education Program. Outcomes were weight and metabolic markers measured at baseline, 6 months, and 12 months. RESULTS Intervention participants lost significantly more weight than controls at 6 months (5.5% vs 0.8%) and 12 months (5.5% vs 0.2%; both P < .001). The intervention group also had significantly greater improvements in hemoglobin A1c and high-density lipoprotein cholesterol level than did controls. CONCLUSIONS A large weight-management program is effective for achieving lifestyle changes associated with diabetes prevention. Such programs could significantly increase the availability of diabetes prevention programs worldwide making an immediate and significant public health impact.
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Affiliation(s)
- David G Marrero
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
| | - Kelly N B Palmer
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
| | - Erin O Phillips
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
| | - Karen Miller-Kovach
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
| | - Gary D Foster
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
| | - Chandan K Saha
- David G. Marrero, Kelly N. B. Palmer, Erin O. Phillips, and Chandan K. Saha are with Indiana University School of Medicine, Indianapolis. Karen Miller-Kovach and Gary D. Foster are with Weight Watchers International
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Neamah HH, Sebert Kuhlmann AK, Tabak RG. Effectiveness of Program Modification Strategies of the Diabetes Prevention Program: A Systematic Review. DIABETES EDUCATOR 2016; 42:153-65. [PMID: 26879459 DOI: 10.1177/0145721716630386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study is to review the effectiveness of commonly used program modifications classified under cultural adaptation and program translational strategies for the Diabetes Prevention Program (DPP) in terms of risk reduction for type 2 diabetes. METHODS Authors extracted data about weight, body mass index (BMI), and 5 areas of program modification strategies from 28 interventions and analyzed them in SPSS software. Bivariate analyses examined the odds of achieving a significant reduction in outcomes by each modification of the DPP and by presence of a maintenance component, as well as the mean reduction of weight and BMI by more versus fewer modifications and by the presence of a maintenance component. RESULTS There were no statistically significant differences in achieving a significant reduction in weight or BMI by any type of modification or by the presence of a maintenance component. Programs with fewer modifications reported significantly greater reduction in mean weight at 12 months postintervention and the furthest time point extracted. Programs with a maintenance component achieved significantly greater reduction in mean weight measured at the furthest time point extracted. CONCLUSIONS The DPP appears to be programmatically robust to a variety of cultural adaptation and translational strategies. Potentially cost-saving modifications do not seem to reduce effectiveness, which should encourage implementation on a broader scale. Program planners should, however, make efforts to include maintenance components because they appear to significantly reduce risk for acquiring type 2 diabetes.
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Affiliation(s)
- Hind H Neamah
- Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Neamah, Dr Sebert Kuhlmann)
| | - Anne K Sebert Kuhlmann
- Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Neamah, Dr Sebert Kuhlmann),Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA (Dr Sebert Kuhlmann)
| | - Rachel G Tabak
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Tabak)
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11
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A review of diabetes prevention program translations: use of cultural adaptation and implementation research. Transl Behav Med 2015; 5:401-14. [PMID: 26622913 DOI: 10.1007/s13142-015-0341-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Diabetes Prevention Program (DPP) has been shown to prevent type 2 diabetes through lifestyle modification. The purpose of this study was to describe the literature on DPP translation, synthesizing studies using cultural adaptation and implementation research. A systematic search was conducted. Original studies evaluating DPP implementation and/or cultural adaptation were included. Data about cultural adaptation, implementation outcomes, and translation strategies was abstracted. A total of 44 were included, of which 15 reported cultural adaptations and 38 explored implementation. Many studies shortened the program length and reported a group format. The most commonly reported cultural adaptation (13 of 15) was with content. At the individual level, the most frequently assessed implementation outcome (n = 30) was adoption. Feasibility was most common (n = 32) at the organization level. The DPP is being tested in a variety of settings and populations, using numerous translational strategies and cultural adaptations. Implementation research that identifies, evaluates, and reports efforts to translate the DPP into practice is crucial.
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12
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Evaluation of physical activity reporting in community Diabetes Prevention Program lifestyle intervention efforts: A systematic review. Prev Med 2015; 77:191-9. [PMID: 26051204 DOI: 10.1016/j.ypmed.2015.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The Diabetes Prevention Program (DPP) lifestyle intervention has been translated to community settings using the DPP goals of 7% weight loss and 150min of moderate physical activity (PA) per week. Given that PA is a primary lifestyle goal and has been linked to improvements in metabolic health in the DPP, it is important to understand the role that PA plays in translation effort success. The purpose of this review is to thoroughly evaluate the reporting of PA methodology and results in DPP-based translations in order to guide future prevention efforts. METHODS PubMed and Ovid databases were searched to identify peer-reviewed original research articles on DPP-based translations for adults at-risk for developing diabetes or cardiovascular disease, limited to English language publications from January 2002-March 2015. RESULTS 72 original research articles describing 57 translation studies met eligibility criteria. All 57 study interventions included a PA goal, 47 studies (82%) collected participant PA information, and 34 (60%) provided PA results. CONCLUSIONS Despite PA being a primary intervention goal, PA methodology and results are under-reported in published DPP translation studies. This absence and inconsistency in reporting PA needs addressed in order to fully understand translation efforts' impact on participant health.
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Brokaw SM, Carpenedo D, Campbell P, Butcher MK, Furshong G, Helgerson SD, Harwell TS. Effectiveness of an Adapted Diabetes Prevention Program Lifestyle Intervention in Older and Younger Adults. J Am Geriatr Soc 2015; 63:1067-74. [PMID: 26031428 DOI: 10.1111/jgs.13428] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare participation, self-monitoring behaviors, and weight loss outcomes in older and younger participants in an adapted Diabetes Prevention Program (DPP) lifestyle intervention. DESIGN Pre- and postevaluation of outcomes in participants enrolled in the Montana Cardiovascular Disease (CVD) and DPP lifestyle intervention from 2008 through 2012. SETTING Community. PARTICIPANTS Adults at high risk for CVD and type 2 diabetes mellitus (N = 3,804). MEASUREMENTS Number of core (16 weekly sessions) and postcore (6 monthly sessions) intervention sessions attended, weekly self-monitoring of fat intake and minutes of physical activity, weight loss outcomes and achievement of the weight loss goal, and improvements in CVD-related risk factors. RESULTS Participants aged 65 and older were significantly more likely to attend more intervention sessions, self-monitor their fat intake, and achieve the physical activity and weight loss goals than those younger than 65. Older and younger participants experienced significant improvements in CVD-related risk factors. CONCLUSION Older adults at high risk of CVD and diabetes mellitus participating in an adapted DPP lifestyle intervention had higher participation and self-monitoring rates than younger participants, were more likely to achieve physical activity and weight loss goals, and achieved similar CVD risk reduction.
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Affiliation(s)
- Sarah M Brokaw
- Montana Department of Public Health and Human Services, Helena, Montana
| | - Dorota Carpenedo
- Montana Department of Public Health and Human Services, Helena, Montana
| | - Paul Campbell
- Montana Department of Public Health and Human Services, Helena, Montana
| | - Marcene K Butcher
- Montana Department of Public Health and Human Services, Helena, Montana
| | - Ginny Furshong
- Montana Department of Public Health and Human Services, Helena, Montana
| | | | - Todd S Harwell
- Montana Department of Public Health and Human Services, Helena, Montana
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Belza B, Petrescu-Prahova M, Kohn M, Miyawaki CE, Farren L, Kline G, Heston AH. Adoption of Evidence-Based Health Promotion Programs: Perspectives of Early Adopters of Enhance(®)Fitness in YMCA-Affiliated Sites. Front Public Health 2015; 2:164. [PMID: 25964904 PMCID: PMC4410415 DOI: 10.3389/fpubh.2014.00164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 09/12/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose To identify facilitators and barriers among early adopters of Enhance®Fitness (EF), in Young Men’s Christian Association-affiliated (Y-affiliated) sites from the perspective of program staff. EF is an evidence-based group exercise program for seniors. Methods This qualitative study used semi-structured phone interviews with 15 staff members representing 14 Y-affiliated sites. Interviews were digitally recorded, transcribed, and analyzed using qualitative content analysis informed by the RE-AIM framework. Findings Staff were, on average, 48.7 years old (SD 13.5) and had been involved with EF for 5.2 years (SD 3.1). Key themes related to facilitating adoption of EF were: match with the Y mission, support from different organizational levels, match between the target population need and EF, initial and on-going financial support, presence of champions, novelty of EF, an invitation to partner with a community-based organization to offer EF, and program-specific characteristics of EF. Key themes related to barriers interfering with EF adoption included competing organizational programs and space limitations, limited resources and expertise, and costs of offering the program. Implications Our findings identify the types of organizational support needed for adoption of evidence-based health promotion programs like EF. Recommendations for practice, research, and policy based on the findings, including assessing organizational readiness, researching late adopters, and developing revenue streams, may help facilitate program adoption. Packaging and sharing these practical recommendations could help community-based agencies and nationally networked organizations facilitate adoption of EF and other evidence-based programs.
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Affiliation(s)
- Basia Belza
- Health Promotion Research Center, University of Washington , Seattle, WA , USA ; School of Nursing, University of Washington , Seattle, WA , USA
| | | | - Marlana Kohn
- Health Promotion Research Center, University of Washington , Seattle, WA , USA
| | - Christina E Miyawaki
- Health Promotion Research Center, University of Washington , Seattle, WA , USA ; School of Social Work, University of Washington , Seattle, WA , USA
| | - Laura Farren
- Health Promotion Research Center, University of Washington , Seattle, WA , USA
| | - Grace Kline
- Health Promotion Research Center, University of Washington , Seattle, WA , USA
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Kramer MK, Molenaar DM, Arena VC, Venditti EM, Meehan RJ, Miller RG, Vanderwood KK, Eaglehouse Y, Kriska AM. Improving employee health: evaluation of a worksite lifestyle change program to decrease risk factors for diabetes and cardiovascular disease. J Occup Environ Med 2015; 57:284-91. [PMID: 25742535 PMCID: PMC4351781 DOI: 10.1097/jom.0000000000000350] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine whether an evidence-based, behavioral lifestyle intervention program delivered at a worksite setting is effective in improving type 2 diabetes and cardiovascular disease risk factors. METHODS A randomized 6-month delayed control design was utilized, with two thirds of the participants assigned to begin intervention immediately, and one third beginning 6 months later. The year-long program (weekly for 3 months transitioning to monthly) focused on weight loss and increasing physical activity. RESULTS The immediate intervention group had greater mean weight loss (-10.4 lb, 5.1%, vs -2.3 lb, 1%; P = 0.0001) than the delayed control group at 6 months and relatively greater improvements in activity, HbA1c, and other risk factors. The delayed group experienced similar improvements after completing the intervention program. CONCLUSIONS A worksite behavioral lifestyle intervention is feasible and effective in significantly improving risk factors for type 2 diabetes and cardiovascular disease.
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Affiliation(s)
- M Kaye Kramer
- From the Department of Epidemiology (Drs Kramer, Kriska, and Vanderwood, Ms Meehan, Ms Miller, and Ms Eaglehouse), University of Pittsburgh Graduate School of Public Health, Pa; Department of Medicine (Dr Molenaar), Veterans Health Administration, Minneapolis, Minn; Department of Biostatistics (Dr Arena), University of Pittsburgh Graduate School of Public Health; and Western Psychiatric Institute and Clinic (Dr Venditti), Pittsburgh, Pa
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16
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Ma Y, Olendzki BC, Wang J, Persuitte GM, Li W, Fang H, Merriam PA, Wedick NM, Ockene IS, Culver AL, Schneider KL, Olendzki GF, Carmody J, Ge T, Zhang Z, Pagoto SL. Single-component versus multicomponent dietary goals for the metabolic syndrome: a randomized trial. Ann Intern Med 2015; 162:248-57. [PMID: 25686165 PMCID: PMC4456033 DOI: 10.7326/m14-0611] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Few studies have compared diets to determine whether a program focused on 1 dietary change results in collateral effects on other untargeted healthy diet components. OBJECTIVE To evaluate a diet focused on increased fiber consumption versus the multicomponent American Heart Association (AHA) dietary guidelines. DESIGN Randomized, controlled trial from June 2009 to January 2014. (ClinicalTrials.gov: NCT00911885). SETTING Worcester, Massachusetts. PARTICIPANTS 240 adults with the metabolic syndrome. INTERVENTION Participants engaged in individual and group sessions. MEASUREMENTS Primary outcome was weight change at 12 months. RESULTS At 12 months, mean change in weight was -2.1 kg (95% CI, -2.9 to -1.3 kg) in the high-fiber diet group versus -2.7 kg (CI, -3.5 to -2.0 kg) in the AHA diet group. The mean between-group difference was 0.6 kg (CI, -0.5 to 1.7 kg). During the trial, 12 (9.9%) and 15 (12.6%) participants dropped out of the high-fiber and AHA diet groups, respectively (P = 0.55). Eight participants developed diabetes (hemoglobin A1c level ≥6.5%) during the trial: 7 in the high-fiber diet group and 1 in the AHA diet group (P = 0.066). LIMITATIONS Generalizability is unknown. Maintenance of weight loss after cessation of group sessions at 12 months was not assessed. Definitive conclusions cannot be made about dietary equivalence because the study was powered for superiority. CONCLUSION The more complex AHA diet may result in up to 1.7 kg more weight loss; however, a simplified approach to weight reduction emphasizing only increased fiber intake may be a reasonable alternative for persons with difficulty adhering to more complicated diet regimens. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Yunsheng Ma
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Barbara C. Olendzki
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Jinsong Wang
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Gioia M. Persuitte
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Wenjun Li
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Hua Fang
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Philip A. Merriam
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Nicole M. Wedick
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Ira S. Ockene
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Annie L. Culver
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Kristin L. Schneider
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Gin-Fei Olendzki
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - James Carmody
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Tingjian Ge
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Zhiying Zhang
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
| | - Sherry L. Pagoto
- From University of Massachusetts Medical School, Worcester, Massachusetts; Medical School of Yangzhou University, Yangzhou, Jiangsu, China; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and University of Massachusetts Lowell, Lowell, Massachusetts
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Brokaw SM, Arave D, Emerson DN, Butcher MK, Helgerson SD, Harwell TS. Intensive lifestyle intervention goals can be achieved as effectively with large groups as with small groups. Prim Care Diabetes 2014; 8:295-300. [PMID: 24630204 DOI: 10.1016/j.pcd.2014.02.002] [Citation(s) in RCA: 5] [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: 07/29/2013] [Revised: 02/14/2014] [Accepted: 02/16/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to assess if group size is associated with weight loss outcomes among participants in an adapted diabetes prevention program. METHODS Adults at high-risk (N=841) for CVD and diabetes were enrolled in the lifestyle intervention in 2011. Multiple logistic regression analyses were used to identify if group size (smaller group<16 participants; larger group ≥16 participants) was independently associated with weight loss outcomes among participants. RESULTS In the bivariate analyses, participants in the smaller groups compared to those in the larger groups were significantly more likely to have a higher baseline body mass index, to attend fewer intervention sessions, and less likely to self-monitor their fat intake for ≥14 weeks, and to have lost less weight during the core intervention (5.1 kg [SD 4.7] versus 5.8 kg [4.5]). However, analysis adjusting for age, sex, baseline BMI, achievement of the physical activity goal, number of weeks self-monitoring fat intake, and group size, found only two factors to be independently associated with achievement of the 7% weight loss goal: frequency of self-monitoring of fat intake and achievement of the physical activity goal. CONCLUSIONS Our findings indicate that intensive lifestyle intervention goals can be achieved as effectively with large or small groups.
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Affiliation(s)
- Sarah M Brokaw
- Montana Department of Public Health and Human Services, Helena, MT, United States
| | - Diane Arave
- Montana Department of Public Health and Human Services, Helena, MT, United States
| | - Derek N Emerson
- Montana Department of Public Health and Human Services, Helena, MT, United States
| | - Marcene K Butcher
- Montana Department of Public Health and Human Services, Helena, MT, United States
| | - Steven D Helgerson
- Montana Department of Public Health and Human Services, Helena, MT, United States
| | - Todd S Harwell
- Montana Department of Public Health and Human Services, Helena, MT, United States.
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Schinckus L, Van den Broucke S, Housiaux M. Assessment of implementation fidelity in diabetes self-management education programs: a systematic review. PATIENT EDUCATION AND COUNSELING 2014; 96:13-21. [PMID: 24795074 DOI: 10.1016/j.pec.2014.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 03/19/2014] [Accepted: 04/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE As diabetes requires extensive self-care, self-management education is widely recommended to enhance the effectiveness and reduce the costs of treatment. While a variety of diabetes self-management (DSM) programs are available, the conditions for their effective implementation are not well documented. This paper reviews the literature on implementation fidelity (IF), the degree to which programs are delivered as intended, as a factor influencing the effectiveness of diabetes education. METHODS Medical, psychological and educational research databases were searched to identify published studies on diabetes education describing the implementation process. Studies detailing the intervention adherence/fidelity/integrity were included to assess the way key elements of IF were addressed. RESULTS From an initial 418 abstracts, 20 published papers were retained for an in-depth analysis focusing on the components of IF. Intervention content was mainly assessed through observation, whereas intervention dose was more often assessed through self-report measures. Only one study addressed the relationship between IF and intervention effectiveness. CONCLUSION Despite the importance of IF to achieve program outcomes, IF of DSM programs remains largely under-investigated. PRACTICE IMPLICATIONS The results of this review suggest that reports on DSM education should systematically describe how the program was implemented. The impact of IF on program outcomes needs further investigation.
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Affiliation(s)
- Louise Schinckus
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium.
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Marie Housiaux
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
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Almeida FA, Pardo KA, Seidel RW, Davy BM, You W, Wall SS, Smith E, Greenawald MH, Estabrooks PA. Design and methods of "diaBEAT-it!": a hybrid preference/randomized control trial design using the RE-AIM framework. Contemp Clin Trials 2014; 38:383-96. [PMID: 24956325 DOI: 10.1016/j.cct.2014.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diabetes prevention is a public health priority that is dependent upon the reach, effectiveness, and cost of intervention strategies. However, understanding each of these outcomes within the context of randomized controlled trials is problematic. PURPOSE To describe the methods and design of a hybrid preference/randomized control trial using the RE-AIM framework. METHODS The trial, which was developed using the RE-AIM framework, will contrast the effects of 3 interventions: (1) a standard care, small group, diabetes prevention education class (SG), (2) the small group intervention plus 12 months of interactive voice response telephone follow-up (SG-IVR), and (3) a DVD version of the small group intervention with the same IVR follow-up (DVD-IVR). Each intervention includes personal action planning with a focus on key elements of the lifestyle intervention from the Diabetes Prevention Program (DPP). Adult patients at risk for diabetes will be randomly assigned to either choice or RCT. Those assigned to choice (n=240) will have the opportunity to choose between SG-IVR and DVD-IVR. Those assigned to RCT group (n=360) will be randomly assigned to SG, SG-IVR, or DVD-IRV. Assessment of primary (weight loss, reach, & cost) and secondary (physical activity, & dietary intake) outcomes will occur at baseline, 6, 12, and 18 months. CONCLUSION This will be the first diabetes prevention trial that will allow the research team to determine the relationships between reach, effectiveness, and cost of different interventions.
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Affiliation(s)
- Fabio A Almeida
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Kimberlee A Pardo
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Richard W Seidel
- Department of Psychiatry, Carilion Clinic, Roanoke, VA 24014, United States.
| | - Brenda M Davy
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Wen You
- Department of Agriculture and Applied Economics, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Sarah S Wall
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Erin Smith
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States.
| | - Mark H Greenawald
- Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24013, United States.
| | - Paul A Estabrooks
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, United States; Department of Family and Community Medicine, Carilion Clinic, Roanoke, VA 24013, United States.
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Brace AM, Padilla HM, DeJoy DM, Wilson MG, Vandenberg RJ, Davis M. Applying RE-AIM to the Evaluation of FUEL Your Life. Health Promot Pract 2014; 16:28-35. [DOI: 10.1177/1524839914539329] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Weight management programs are becoming increasingly common in workplace settings; however, few target middle-aged men. The purpose of this article is to describe the process evaluation of a worksite translation of the Diabetes Prevention Program in a predominantly middle-aged male population. The translated program, FUEL Your Life, was largely self-directed, with support from peer health coaches and occupational health nurses. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to examine the factors that influenced program implementation using data from an environmental assessment, participant surveys, peer health coach surveys, and occupational health nurse interviews. An overwhelming majority of the employees who enrolled in the study were overweight or obese (92%). Overall, the program was effective for weight maintenance; those with higher levels of participation and engagement had better weight loss outcomes. The peer health coach and family elements of the intervention were underused. The program was successful in reaching the intended population; however, the program had limited success in engaging this population. Not surprisingly, weight loss was a function of participant engagement and participation. Increasing participant engagement and participation is important to the success of weight management interventions translated to the worksite setting. Garnering buy-in and support from management can serve to increase the perceived importance of weight management in worksites. With management support, weight management protocols could be integrated as a component of the mandatory safety and health assessments already in place, fostering promotion of healthy weight in the workforce.
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Greenwood DA, Kramer MK, Hankins AI, Parise CA, Fox A, Buss KA. Adapting the Group Lifestyle Balance™ Program for Weight Management Within a Large Health Care System Diabetes Education Program. DIABETES EDUCATOR 2014; 40:299-307. [PMID: 24562606 DOI: 10.1177/0145721714524281] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this translation study was to evaluate the feasibility and effectiveness of an adapted Group Lifestyle Balance (GLB) intervention for weight management implemented through an existing diabetes education program within a large health care delivery system for overweight/obese individuals with diabetes, prediabetes, or neither condition. METHODS Adults with BMI ≥ 25 kg/m2 participated in an adapted GLB intervention designed to be appropriate regardless of diabetes status. Effectiveness was based on changes in weight and minutes of physical activity between baseline and completion of the 12-week core. Differences between subjects based on diabetes status were also examined. RESULTS A total of 111 subjects with diabetes, prediabetes, and no diabetes completed baseline survey data and attended at least 9 of the 12 core sessions from April 2010 through December 2011. All achieved significant weight loss, and the proportion of subjects who reported exercising at least 150 minutes/week increased. CONCLUSIONS The adapted GLB intervention for weight management implemented through an existing diabetes education program in a large health care system was feasible and effective in the population, regardless of participants' diabetes status.
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Affiliation(s)
- Deborah A Greenwood
- Sutter Health Integrated Diabetes Education Network, Sutter Medical Foundation, Sacramento, California (Ms Greenwood, Mrs Fox, Dr Buss)
| | - M Kaye Kramer
- Diabetes Prevention and Support Center, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Kramer)
| | - Andrea I Hankins
- Sutter Institute for Medical Research, Sacramento, California (Ms Hankins, Dr Parise)
| | - Carol A Parise
- Sutter Institute for Medical Research, Sacramento, California (Ms Hankins, Dr Parise)
| | - Amy Fox
- Sutter Health Integrated Diabetes Education Network, Sutter Medical Foundation, Sacramento, California (Ms Greenwood, Mrs Fox, Dr Buss)
| | - Kimberly A Buss
- Sutter Health Integrated Diabetes Education Network, Sutter Medical Foundation, Sacramento, California (Ms Greenwood, Mrs Fox, Dr Buss)
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W Seidel R, Pardo KA, A Estabrooks P, WenYou EY, Wall SS, M Davy B, A Almeida F. Beginning a patient-centered approach in the design of a diabetes prevention program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:2003-13. [PMID: 24534767 PMCID: PMC3945581 DOI: 10.3390/ijerph110202003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The purpose of this study was to identify patient preferences for different components of a local diabetes prevention program that would improve reach. A secondary purpose was to determine if patient characteristics were related to program preferences. METHODS Participants were identified through electronic medical records from two family medicine clinics in Virginia. Participants completed a mailed survey addressing demographics, economic status, risk factors for diabetes, and preferences regarding diabetes prevention interventions-delivery mode, program length, and duration. RESULTS Twenty-nine percent of eligible participants responded (n = 142); 83% of participants were at risk for diabetes and 82% had a household income <$20,000. When presented with the choice between a class-based vs. a technology-based program, 83% preferred a technology-based program. Whites were less likely to choose the technology-based program, with no significant differences based on age, education, income, or gender. CONCLUSIONS Contrary to beliefs that lower income individuals may not use technology-based interventions, lower socioeconomic patients indicated a preference for a technology- and telephone-supported diabetes prevention program over in-person class approaches. Findings provide formative data to support the design of a patient-centered, technology-enhanced diabetes prevention program in a real-world setting, thereby increasing potential participation and reach.
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Affiliation(s)
- Richard W Seidel
- Department of Psychiatry, Virginia Tech Carilion School of Medicine, 2017 South Jefferson Street, Roanoke, VA 24014, USA.
| | - Kimberlee A Pardo
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
| | - Paul A Estabrooks
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
| | - Emptyyn Y WenYou
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
| | - Sarah S Wall
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
| | - Brenda M Davy
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
| | - Fabio A Almeida
- Fralin Translational Obesity Research Center, Department of Human Nutrition, Foods and Exercise, Virginia Tech, 215 War Memorial Hall, Blacksburg, VA 24061, USA.
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Venditti EM, Wylie-Rosett J, Delahanty LM, Mele L, Hoskin MA, Edelstein SL. Short and long-term lifestyle coaching approaches used to address diverse participant barriers to weight loss and physical activity adherence. Int J Behav Nutr Phys Act 2014; 11:16. [PMID: 24521153 PMCID: PMC4015875 DOI: 10.1186/1479-5868-11-16] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Individual barriers to weight loss and physical activity goals in the Diabetes Prevention Program, a randomized trial with 3.2 years average treatment duration, have not been previously reported. Evaluating barriers and the lifestyle coaching approaches used to improve adherence in a large, diverse participant cohort can inform dissemination efforts. Methods Lifestyle coaches documented barriers and approaches after each session (mean session attendance = 50.3 ± 21.8). Subjects were 1076 intensive lifestyle participants (mean age = 50.6 years; mean BMI = 33.9 kg/m2; 68% female, 48% non-Caucasian). Barriers and approaches used to improve adherence were ranked by the percentage of the cohort for whom they applied. Barrier groupings were also analyzed in relation to baseline demographic characteristics. Results Top weight loss barriers reported were problems with self-monitoring (58%); social cues (58%); holidays (54%); low activity (48%); and internal cues (thought/mood) (44%). Top activity barriers were holidays (51%); time management (50%); internal cues (30%); illness (29%), and motivation (26%). The percentage of the cohort having any type of barrier increased over the long-term intervention period. A majority of the weight loss barriers were significantly associated with younger age, greater obesity, and non-Caucasian race/ethnicity (p-values vary). Physical activity barriers, particularly thought and mood cues, social cues and time management, physical injury or illness and access/weather, were most significantly associated with being female and obese (p < 0.001 for all). Lifestyle coaches used problem-solving with most participants (≥75% short-term; > 90% long term) and regularly reviewed self-monitoring skills. More costly approaches were used infrequently during the first 16 sessions (≤10%) but increased over 3.2 years. Conclusion Behavioral problem solving approaches have short and long term dissemination potential for many kinds of participant barriers. Given minimal resources, increased attention to training lifestyle coaches in the consistent use of these approaches appears warranted.
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Affiliation(s)
- Elizabeth M Venditti
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical School, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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Pagoto S, Schneider KL, Whited MC, Oleski JL, Merriam P, Appelhans B, Ma Y, Olendzki B, Waring ME, Busch AM, Lemon S, Ockene I, Crawford S. Randomized controlled trial of behavioral treatment for comorbid obesity and depression in women: the Be Active Trial. Int J Obes (Lond) 2013; 37:1427-34. [PMID: 23459323 PMCID: PMC3675166 DOI: 10.1038/ijo.2013.25] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 01/04/2013] [Accepted: 01/13/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Depression is associated with increased risk for obesity and worse weight loss treatment outcomes. The purpose of the present study was to test the hypothesis that delivering evidence-based behavior therapy for depression before a lifestyle weight loss intervention improves both weight loss and depression. DESIGN In a randomized controlled trial, obese women with major depressive disorder (N=161, mean age=45.9 (s.d.: 10.8) years) were randomized to brief behavior therapy for depression treatment followed by a lifestyle intervention (BA) or a lifestyle intervention only (LI). Follow-up occurred at 6 and 12 months. Main outcome measures included weight loss and depression symptoms. RESULTS Intention-to-treat analyses revealed both conditions lost significant weight, but no differences between conditions in weight change at 6 months (BA=-3.0%, s.e.=-0.65%; LI=-3.7%, s.e.=0.63%; P=0.48) or 12 months (BA=-2.6%, s.e.=0.77%; LI=-3.1%, s.e.=0.74%; P=0.72). However, the BA condition evidenced significantly greater improvement in Beck Depression Inventory-II scores relative to the LI condition at both 6 months (BA mean change=-12.5, s.d.=0.85; LI mean change=-9.2, s.d.=0.80, P=0.005) and 12 months (BA mean change=-12.6, s.d.=0.97; LI mean change=-9.9, s.d.=0.93; P=0.045). Participants who experienced depression remission by 6 months (61.2%) lost greater weight (mean=-4.31%; s.e.=0.052) than those who did not (39.7%; mean=-2.47%, s.e.=0.53; P=.001). CONCLUSION Adding behavior therapy to a lifestyle intervention results in greater depression remission but does not improve weight loss within 1 year. Improvement in depression is associated with greater weight loss.
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Affiliation(s)
- S Pagoto
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Pagoto S, Schneider K, Jojic M, DeBiasse M, Mann D. Evidence-based strategies in weight-loss mobile apps. Am J Prev Med 2013; 45:576-82. [PMID: 24139770 DOI: 10.1016/j.amepre.2013.04.025] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 03/04/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Physicians have limited time for weight-loss counseling, and there is a lack of resources to which they can refer patients for assistance with weight loss. Weight-loss mobile applications (apps) have the potential to be a helpful tool, but the extent to which they include the behavioral strategies included in evidence-based interventions is unknown. PURPOSE The primary aims of the study were to determine the degree to which commercial weight-loss mobile apps include the behavioral strategies included in evidence-based weight-loss interventions, and to identify features that enhance behavioral strategies via technology. METHODS Thirty weight-loss mobile apps, available on iPhone and/or Android platforms, were coded for whether they included any of 20 behavioral strategies derived from an evidence-based weight-loss program (i.e., Diabetes Prevention Program). Data on available apps were collected in January 2012; data were analyzed in June 2012. RESULTS The apps included on average 18.83% (SD=13.24; range=0%-65%) of the 20 strategies. Seven of the strategies were not found in any app. The most common technology-enhanced features were barcode scanners (56.7%) and a social network (46.7%). CONCLUSIONS Weight-loss mobile apps typically included only a minority of the behavioral strategies found in evidence-based weight-loss interventions. Behavioral strategies that help improve motivation, reduce stress, and assist with problem solving were missing across apps. Inclusion of additional strategies could make apps more helpful to users who have motivational challenges.
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Affiliation(s)
- Sherry Pagoto
- University of Massachusetts Medical School (Pagoto, Jojic), Worcester.
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Translation of the diabetes prevention program into a community mental health organization for individuals with severe mental illness: a case study. Transl Behav Med 2013; 1:453-60. [PMID: 24073066 DOI: 10.1007/s13142-011-0053-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Individuals with severe mental illness (SMI) have significant health disparities. Wellness services embedded in community mental health organizations could lessen these disparities. This case study illustrates the integration of the Diabetes Prevention Program (DPP) lifestyle intervention into a community mental health organization. The Diffusion of Innovations Theory was used as a model for integration, which included a collaboration between researchers and the organization and qualitative work, culminating in a small pilot of the DPP led by peer specialists to test the feasibility of the DPP in this setting. Fourteen individuals with SMI participated in the 19-week intervention. Three dropped out, but the remaining 11 demonstrated 92% attendance. Weight loss was minimal, but the participants reported benefit and showed continued interest in the intervention. The use of a peer-led DPP in a community mental health organization is feasible and warrants further investigation to demonstrate efficacy.
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Jiang L, Manson SM, Beals J, Henderson WG, Huang H, Acton KJ, Roubideaux Y. Translating the Diabetes Prevention Program into American Indian and Alaska Native communities: results from the Special Diabetes Program for Indians Diabetes Prevention demonstration project. Diabetes Care 2013; 36:2027-34. [PMID: 23275375 PMCID: PMC3687272 DOI: 10.2337/dc12-1250] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The landmark Diabetes Prevention Program (DPP) showed that lifestyle intervention can prevent or delay the onset of diabetes for those at risk. We evaluated a translational implementation of this intervention in a diverse set of American Indian and Alaska Native (AI/AN) communities. RESEARCH DESIGN AND METHODS The Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP) demonstration project implemented the DPP lifestyle intervention among 36 health care programs serving 80 tribes. A total of 2,553 participants with prediabetes were recruited and started intervention by 31 July 2008. They were offered the 16-session Lifestyle Balance Curriculum and underwent a thorough clinical assessment for evaluation of their diabetes status and risk at baseline, soon after completing the curriculum (postcurriculum), and annually for up to 3 years. Diabetes incidence was estimated. Weight loss, changes in blood pressure and lipid levels, and lifestyle changes after intervention were also evaluated. RESULTS The completion rates of SDPI-DP were 74, 59, 42, and 33% for the postcurriculum and year 1, 2, and 3 assessments, respectively. The crude incidence of diabetes among SDPI-DP participants was 4.0% per year. Significant improvements in weight, blood pressure, and lipid levels were observed immediately after the intervention and annually thereafter for 3 years. Class attendance strongly correlated with diabetes incidence rate, weight loss, and change in systolic blood pressure. CONCLUSIONS Our findings demonstrate the feasibility and potential of translating the lifestyle intervention in diverse AI/AN communities. They have important implications for future dissemination and institutionalization of the intervention throughout the Native American health system.
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Affiliation(s)
- Luohua Jiang
- Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Texas, USA.
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Koller EA, Chin JS, Conway PH. Diabetes prevention and the role of risk factor reduction in the Medicare population. Am J Prev Med 2013; 44:S307-16. [PMID: 23498292 DOI: 10.1016/j.amepre.2012.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 10/12/2012] [Accepted: 12/11/2012] [Indexed: 01/12/2023]
Abstract
Medicare is keenly aware of the secular changes in weight gain and of the nearly parallel increases in both the incidence and prevalence of type 2 diabetes throughout the U.S. population. The Medicare population, however, differs from the population at large because of its advanced age and frequency of comorbid conditions and/or disability. These factors affect life span as well as participation in and potential benefit from lifestyle modification and risk-factor reduction activities. Further, macrovascular disease is the greatest burden for older beneficiaries with diabetes, and its risks may antedate the appearance of hyperglycemia. Both diabetes prevention and treatment must be considered in this context. Medicare benefits focus on reduction of cardiovascular risk and mitigation of more temporally immediate complications of weight gain and glucose elevation. These preventive services and interventions are described.
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Affiliation(s)
- Elizabeth A Koller
- Coverage and Analysis Group, Centers for Medicare and Medicaid Services, Woodlawn, Maryland 21244, USA.
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Venditti EM, Kramer MK. Diabetes Prevention Program community outreach: perspectives on lifestyle training and translation. Am J Prev Med 2013; 44:S339-45. [PMID: 23498296 PMCID: PMC3609413 DOI: 10.1016/j.amepre.2012.12.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 10/19/2012] [Accepted: 12/11/2012] [Indexed: 12/31/2022]
Abstract
The gap between what is known from clinical efficacy research and the systematic community translation of diabetes prevention programs is narrowing. During the past 5 years, numerous randomized and nonrandomized dissemination studies have evaluated the modified delivery of structured Diabetes Prevention Program (DPP) interventions in diverse real-world settings. Programs of sufficient dose and duration, implemented with fidelity, have reported weight losses in the range of 4%-7% with associated improvements in cardiometabolic risk factors at 6 and 12 months from baseline. The current article describes some of the experiences and perspectives of a team of University of Pittsburgh researchers as they have engaged in these efforts.
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Affiliation(s)
- Elizabeth M Venditti
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Sakane N, Kotani K, Takahashi K, Sano Y, Tsuzaki K, Okazaki K, Sato J, Suzuki S, Morita S, Izumi K, Kato M, Ishizuka N, Noda M, Kuzuya H. Japan Diabetes Outcome Intervention Trial-1 (J-DOIT1), a nationwide cluster randomized trial of type 2 diabetes prevention by telephone-delivered lifestyle support for high-risk subjects detected at health checkups: rationale, design, and recruitment. BMC Public Health 2013; 13:81. [PMID: 23356246 PMCID: PMC3579679 DOI: 10.1186/1471-2458-13-81] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 01/22/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Lifestyle modifications are considered the most effective means of delaying or preventing the development of type 2 diabetes (T2DM). To contain the growing population of T2DM, it is critical to clarify effective and efficient settings for intervention and modalities for intervention delivery with a wide population reach.The Japan Diabetes Outcome Intervention Trial-1 (J-DOIT1) is a cluster randomized controlled trial to test whether goal-focused lifestyle coaching delivered by telephone can prevent the development of T2DM in high-risk individuals in a real-world setting. This paper describes the study design and recruitment of the study subjects. METHODS For the recruitment of study subjects and their follow-up annually over 3 years, we employed health checkups conducted annually at communities and worksites. Health care divisions recruited from communities and companies across Japan formed groups as a cluster randomization unit. Candidates for the study, aged 20-65 years with fasting plasma glucose (FPG) of 5.6-6.9 mmol/l, were recruited from each group using health checkups results in 2006. Goal-focused lifestyle support is delivered by healthcare providers via telephone over a one-year period. Study subjects will be followed-up for three years by annual health checkups. Primary outcome is the development of diabetes defined as FPG≥7.0 mmol/l on annual health checkup or based on self-report, which is confirmed by referring to medical cards. RESULTS Forty-three groups (clusters), formed from 17 health care divisions, were randomly assigned to an intervention arm (22 groups) or control arm (21 clusters) between March 2007 and February 2008. A total of 2840 participants, 1336 from the intervention and 1504 from the control arm, were recruited. Consent rate was about 20%, with no difference between the intervention and control arms. There were no differences in cluster size and characteristics of cluster between the groups. There were no differences in individual characteristics between the study arms. CONCLUSION We have launched J-DOIT1, a nation-wide trial to prevent the development of T2DM in high-risk individuals using telephone-delivered intervention. This trial is expected to contribute to evidence-based real-world preventive practices. TRIAL REGISTRATION UMIN000000662.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazuhiko Kotani
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kaoru Takahashi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Hyogo Health Service Association, Hyogo, Japan
| | - Yoshiko Sano
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kokoro Tsuzaki
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kentaro Okazaki
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Juichi Sato
- Department of General Medicine/Family & Community Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Morita
- Department of Biostatistics and Epidemiology, Yokohama City University, Yokohama, Japan
| | - Kazuo Izumi
- Office of Strategic Outcomes Research Program, Japan Foundation for the Promotion of International Medical Research Corporation, Tokyo, Japan
- Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayuki Kato
- Office of Strategic Outcomes Research Program, Japan Foundation for the Promotion of International Medical Research Corporation, Tokyo, Japan
| | - Naoki Ishizuka
- Biostatistics, Biostatistics & Programming Clinical Sciences & Operation Research & Development, Sanofi K.K, Tokyo, Japan
| | - Mitsuhiko Noda
- Office of Strategic Outcomes Research Program, Japan Foundation for the Promotion of International Medical Research Corporation, Tokyo, Japan
- Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan
- Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideshi Kuzuya
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Koseikai Takeda Hospital, Kyoto, Japan
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DeJoy DM, Padilla HM, Wilson MG, Vandenberg RJ, Davis MA. Worksite translation of the Diabetes Prevention Program: formative research and pilot study results from FUEL Your Life. Health Promot Pract 2012; 14:506-13. [PMID: 23091301 DOI: 10.1177/1524839912461014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article summarizes formative research and pilot study findings from a workplace translation of the Diabetes Prevention Program (DPP). The overarching goal was to devise a relatively straightforward weight management intervention suitable for use in a wide array of work settings. This project was conducted in conjunction with Union Pacific Railroad at one of their locomotive maintenance facilities. Participating employees were predominately male and middle-aged. Formative data were collected through stakeholder interviews, focus groups, and direct observation of the work environment. These results were used to adapt the DPP into a largely self-directed intervention augmented by peer health coaches and the on-site nurse. A small pilot test of the adapted program (n = 67) produced modest but statistically significant weight reductions at both 6 (core intervention period) and 12 months (maintenance period). These results are discussed in terms of the original DPP and other DPP translation studies.
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Affiliation(s)
- David M DeJoy
- College of Public Health, University of Georgia, Athens, GA 30602-6522, USA.
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Kanaya AM, Santoyo-Olsson J, Gregorich S, Grossman M, Moore T, Stewart AL. The Live Well, Be Well study: a community-based, translational lifestyle program to lower diabetes risk factors in ethnic minority and lower-socioeconomic status adults. Am J Public Health 2012; 102:1551-8. [PMID: 22698027 DOI: 10.2105/ajph.2011.300456] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated a community-based, translational lifestyle program to reduce diabetes risk in lower-socioeconomic status (SES) and ethnic minority adults. METHODS Through an academic-public health department partnership, community-dwelling adults at risk for diabetes were randomly assigned to individualized lifestyle counseling delivered primarily via telephone by health department counselors or a wait-list control group. Primary outcomes (6 and 12 months) were fasting glucose level, triglycerides, high- and low-density lipoprotein cholesterol, weight, waist circumference, and systolic blood pressure. Secondary outcomes included diet, physical activity, and health-related quality of life. RESULTS Of the 230 participants, study retention was 92%. The 6-month group differences for weight and triglycerides were significant. The intervention group lost 2 pounds more than did the control group (P=.03) and had decreased triglyceride levels (difference in change, 23 mg/dL; P=.02). At 6 months, the intervention group consumed 7.7 fewer grams per day of fat (P=.05) and more fruits and vegetables (P=.02) than did control participants. CONCLUSIONS Despite challenges designing effective translational interventions for lower-SES and minority communities, this program modestly improved some diabetes risk factors. Thus, individualized, telephone-based models may be a promising alternative to group-based interventions.
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Affiliation(s)
- Alka M Kanaya
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA 94115, USA.
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Tang TS, Nwankwo R, Whiten Y, Oney C. Training peers to deliver a church-based diabetes prevention program. DIABETES EDUCATOR 2012; 38:519-25. [PMID: 22609761 DOI: 10.1177/0145721712447982] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to examine the feasibility and acceptability of training peers to function as lifestyle coaches and to deliver a church-based lifestyle modification program. METHODS We recruited 6 African-American adults to participate in an 8-hour peer lifestyle coach (PLC) training program followed by a subsequent 2-hour booster session. The PLC training program addressed several key areas, including: (1) developing empowerment-based facilitation, active listening, and behavior change skills; (2) learning self-management strategies (eg, reading food labels, counting calories); (3) practicing session delivery; and (4) interpreting clinical lab results. Training evaluation was conducted retrospectively (immediately following the delivery of the diabetes prevention intervention rather than after the 8-hour training session) and measured program satisfaction and efficacy from the perspective of participants. RESULTS Peer lifestyle coaches' confidence levels for performing core skills (eg, asking open-ended questions, 5-step behavioral goal-setting process) and advanced skills (eg, addressing resistance, discussing sensitive topics) were uniformly high. Similarly, PLCs were very satisfied with the length of training, balance between content and skills development, and preparation for leading group- and individual-based support activities. CONCLUSIONS Findings suggest that it is feasible to customize a PLC training program that is acceptable to participants and that equips participants with the knowledge and skills to facilitate a church-based diabetes prevention intervention.
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, University of British Columbia School of Medicine, Vancouver, British Columbia, Canada,Department of Medical Education, University of Michigan Medical School, Ann Arbor, USA
| | - Robin Nwankwo
- Department of Medical Education, University of Michigan Medical School, Ann Arbor, USA
| | | | - Christina Oney
- Department of Personality & Social Contexts Psychology, School of Psychology, University of Michigan, Ann Arbor, MI, USA
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Abstract
Several efficacy trials and subsequent dissemination studies indicate that behavioral lifestyle interventions for diabetes risk reduction require, at a minimum, provision of 4 to 6 months of frequent intervention contact to induce clinically meaningful weight losses of at least 5% of initial body weight. Weekly contact during the first several months of intervention, followed by less frequent but regular therapeutic contact for a longer time period, appears necessary for participants to adopt and enact behavioral self-regulatory skills such as the self-monitoring of diet, weight, and physical activity and the problem solving of common physical, social, and cognitive barriers that impede sustained weight loss. In-person contact is associated with the largest effect sizes but may not be a necessary component for clinically meaningful weight loss. Regardless of intervention mode, setting, or provider, the interactive process of feedback and social support is crucial for skill development and sustained weight loss.
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Affiliation(s)
- Elizabeth M Venditti
- Diabetes Prevention Program Outcomes Study, Western Psychiatric Institute and Clinics, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Kramer MK, McWilliams JR, Chen HY, Siminerio LM. A community-based diabetes prevention program: evaluation of the group lifestyle balance program delivered by diabetes educators. DIABETES EDUCATOR 2012; 37:659-68. [PMID: 21918204 DOI: 10.1177/0145721711411930] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE With growing numbers of people at risk for diabetes and cardiovascular disease, diabetes educators report increasing referrals for intervention in prevention of these conditions. Diabetes educators have expertise in diabetes self-management education; however, they are generally not prepared for delivery of chronic disease primary prevention. The purpose of this project was to determine if individuals at risk for diabetes who participate in an intervention delivered by trained diabetes educators in existing diabetes self-management education community-based programs can reduce risk factors for diabetes and cardiovascular disease. METHODS Diabetes educators in 3 outpatient-hospital programs (urban, suburban, and rural) received training and support for implementation of the Group Lifestyle Balance program, an adaptation of the Diabetes Prevention Program lifestyle intervention, from the Diabetes Prevention Support Center of the University of Pittsburgh. Adults with prediabetes and/or the metabolic syndrome were eligible to enroll in the program with physician referral. With use of existing diabetes educator networks, recruitment was completed via on-site physician in-services, informative letters, and e-mail contact as well as participant-directed newspaper advertisement. RESULTS Eighty-one participants enrolled in the study (71 women, 10 men). Mean overall weight loss was 11.3 lb (5.1%, P < .001); in addition, significant decreases were noted in fasting plasma glucose, low-density lipoprotein cholesterol, triglycerides, and blood pressure. CONCLUSIONS These results suggest that the Group Lifestyle Balance program delivered by diabetes educators was successful in reducing risk for diabetes and cardiovascular disease in high-risk individuals. Furthermore, diabetes educators, already integrated within the existing health care system, provide yet another resource for delivery of primary prevention programs in the community.
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Affiliation(s)
- M Kaye Kramer
- The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Kramer, Ms Chen)
| | - Janis R McWilliams
- The University of Pittsburgh Medical Center, Pittsburgh,Pennsylvania (Ms McWilliams)
| | - Hsiang-Yu Chen
- The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Kramer, Ms Chen)
| | - Linda M Siminerio
- The School of Medicine and Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Siminerio)
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Ockene JK, Schneider KL, Lemon SC, Ockene IS. Can we improve adherence to preventive therapies for cardiovascular health? Circulation 2011; 124:1276-82. [PMID: 21911795 DOI: 10.1161/circulationaha.110.968479] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Judith K Ockene
- University of Massachusetts Medical School, Worcester, 01655, USA.
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West DS, Bursac Z, Cornell CE, Felix HC, Fausett JK, Krukowski RA, Lensing S, Love SJ, Prewitt TE, Beck C. Lay health educators translate a weight-loss intervention in senior centers: a randomized controlled trial. Am J Prev Med 2011; 41:385-91. [PMID: 21961465 PMCID: PMC6737925 DOI: 10.1016/j.amepre.2011.06.041] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 04/19/2011] [Accepted: 06/09/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Older adults have high obesity rates and respond well to evidence-based weight-loss programs, such as the Diabetes Prevention Program (DPP) Lifestyle intervention. The goal of this study was to determine whether a translation of the DPP Lifestyle program delivered by lay health educators and conducted in senior centers is effective in promoting weight loss among older adults. DESIGN An RCT with older adults nested within senior centers. Senior centers identified lay health educators to receive training and deliver the intervention program at the senior center. Senior centers were randomized to DPP Lifestyle program or an attention control intervention (cognitive training). SETTING/PARTICIPANTS Senior centers (N=15) located throughout Arkansas. Participants (N=228) were obese (BMI=34.5±4.9) older (aged 71.2±6.6 years) adults able to engage in moderate exercise. Follow-up data were collected at 4 months on 93% of the original cohort between February 2009 and July 2010. INTERVENTIONS A 12-session translation of the Diabetes Prevention Program Lifestyle behavioral weight-control program delivered in group sessions by trained lay health educators. MAIN OUTCOME MEASURES Body weight was assessed by digital scale. Percentage weight loss from baseline and proportion achieving ≥5% and ≥7% weight loss were examined. Analyses were completed in March 2011. RESULTS Participants attending senior centers randomized to Lifestyle lost a significantly greater percentage of baseline weight (3.8%, 95% CI=2.9%, 4.6%) than those in the control senior centers (0.2%, 95% CI= -0.6%, -0.9%) after adjusting for baseline BMI and gender (p<0.001). Among participants attending senior centers offering the Lifestyle program, 38% lost ≥5% of baseline weight compared with 5% in the control arm (p<0.001). Similarly, significantly more participants (24%) in Lifestyle senior centers lost ≥7% than did control participants (3%, p=0.001). CONCLUSIONS A behavioral lifestyle weight-loss intervention delivered by a lay health educator offers a promising vehicle for translation of evidence-based obesity treatment programs in underserved areas. TRIAL REGISTRATION This study is registered at Clinicaltrials.govNCT01377506.
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Affiliation(s)
- Delia Smith West
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, USA.
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Pagoto S. The current state of lifestyle intervention implementation research: where do we go next? Transl Behav Med 2011; 1:401-5. [PMID: 24073065 PMCID: PMC3717623 DOI: 10.1007/s13142-011-0071-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Sherry Pagoto
- University of Massachusetts Medical School, Worcester, MA USA
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Whittemore R. A systematic review of the translational research on the Diabetes Prevention Program. Transl Behav Med 2011; 1:480-91. [PMID: 24073067 PMCID: PMC3717627 DOI: 10.1007/s13142-011-0062-y] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
International clinical trials have demonstrated compelling evidence on the prevention or delay of type 2 diabetes (T2D) by lifestyle change programs. Numerous studies have translated the Diabetes Prevention Program (DPP) protocol to "real-world" settings. The purpose of this paper is to review the translational research of the DPP protocol in adults at-risk for T2D. This study is a systematic review based on the guidelines from the Cochrane Handbook for Systematic Reviews. There were 16 studies that translated the DPP protocol in four distinct settings: (a) hospital outpatient, (b) primary care, (c) community, and (d) work and church. Settings varied considerably in terms of reach, efficacy, adoption, implementation, and maintenance. There were strengths and limitations to each setting. Better understanding of program adaptation and mediators and moderators to program efficacy are indicated. Future research also needs to continue to explore mechanisms to improve access and long-term outcomes.
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Affiliation(s)
- Robin Whittemore
- Yale School of Nursing, 100 Church Street South, New Haven, CT 06536 USA
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Harwell TS, Vanderwood KK, Hall TO, Butcher MK, Helgerson SD. Factors associated with achieving a weight loss goal among participants in an adapted Diabetes Prevention Program. Prim Care Diabetes 2011; 5:125-129. [PMID: 21233033 DOI: 10.1016/j.pcd.2010.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/13/2010] [Accepted: 12/14/2010] [Indexed: 12/21/2022]
Abstract
AIMS To assess the factors associated with achieving the 7% weight loss goal among participants enrolled in an adapted Diabetes Prevention Program (DPP). METHODS Adults at high-risk (N=989) for CVD and diabetes were enrolled in the lifestyle intervention. Multiple logistic regression analyses were used to identify factors associated with achieving the weight loss goal. RESULTS Overall 37% of participants achieved the weight loss goal. Participants who were older, male, had a lower baseline BMI, self-monitored their fat and caloric intake more frequently, and who achieved higher levels of physical activity were more likely to achieve the weight loss goal compared to participants without these characteristics. In multivariate analyses more frequent self-monitoring of fat and caloric intake and higher levels of weekly physical activity were the only factors independently associated with participant achievement of the weight loss goal. CONCLUSIONS In a real-world translation of the DPP lifestyle intervention participants who achieved the weight loss goal were more likely to have monitored their dietary intake frequently and increased their physical activity markedly both in a dose-response relationship. Our findings highlight the importance of supporting participants in lifestyle interventions to initiate and maintain dietary self-monitoring and increased levels of physical activity.
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Affiliation(s)
- Todd S Harwell
- Montana Department of Public Health and Human Services, Helena, MT 59620-2951, USA.
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Courtney MR, Conard SE, Dunn P, Scarborough K. The Game of Health©: An innovative lifestyle change program implemented in a family practice. ACTA ACUST UNITED AC 2011; 23:289-97. [DOI: 10.1111/j.1745-7599.2011.00604.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vanderwood KK, Hall TO, Harwell TS, Arave D, Butcher MK, Helgerson SD. Factors associated with the maintenance or achievement of the weight loss goal at follow-up among participants completing an adapted diabetes prevention program. Diabetes Res Clin Pract 2011; 91:141-7. [PMID: 21194779 DOI: 10.1016/j.diabres.2010.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 11/29/2010] [Accepted: 12/01/2010] [Indexed: 11/19/2022]
Abstract
AIMS This study evaluated factors associated with achievement or maintenance of a 7% weight loss goal post intervention among adults at high-risk for cardiovascular disease (CVD) and diabetes who participated in an adapted Diabetes Prevention Program (DPP) intervention. MATERIALS AND METHODS High-risk adults completed the intervention in 2008 or 2009 (N=466). In 2010, we conducted a follow-up survey of participants to assess characteristics, behaviors and barriers associated with the maintenance or achievement of the weight loss goal. RESULTS Thirty-nine percent of respondents (73/188) maintained or achieved the goal post intervention. Participants who achieved the goal were more likely to have attended more intervention sessions, and to have lost more weight during the intervention compared to participants who did not achieve the goal. Participants who achieved or maintained the goal post intervention were more likely to engage in behaviors related to weight loss maintenance. DISCUSSION Our findings suggest maintenance or achievement of a weight loss goal post intervention among participants in an adapted lifestyle intervention is consistent with the original DPP. Our findings also highlight the relationship between maintaining or achieving a weight loss goal post intervention and behaviors that can be reinforced and barriers that can be mitigated.
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Affiliation(s)
- Karl K Vanderwood
- Montana Department of Public Health and Human Services, Helena, MT, United States.
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Reduction of diabetes risk in routine clinical practice: are physical activity and nutrition interventions feasible and are the outcomes from reference trials replicable? A systematic review and meta-analysis. BMC Public Health 2010; 10:653. [PMID: 21029469 PMCID: PMC2989959 DOI: 10.1186/1471-2458-10-653] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 10/29/2010] [Indexed: 12/18/2022] Open
Abstract
Background The clinical effectiveness of intensive lifestyle interventions in preventing or delaying diabetes in people at high risk has been established from randomised trials of structured, intensive interventions conducted in several countries over the past two decades. The challenge is to translate them into routine clinical settings. The objective of this review is to determine whether lifestyle interventions delivered to high-risk adult patients in routine clinical care settings are feasible and effective in achieving reductions in risk factors for diabetes. Methods Data sources: MEDLINE (PubMed), EMBASE, CINAHL, The Cochrane Library, Google Scholar, and grey literature were searched for English-language articles published from January 1990 to August 2009. The reference lists of all articles collected were checked to ensure that no relevant suitable studies were missed. Study selection: We included RCTs, before/after evaluations, cohort studies with or without a control group and interrupted time series analyses of lifestyle interventions with the stated aim of diabetes risk reduction or diabetes prevention, conducted in routine clinical settings and delivered by healthcare providers such as family physicians, practice nurses, allied health personnel, or other healthcare staff associated with a health service. Outcomes of interest were weight loss, reduction in waist circumference, improvement of impaired fasting glucose or oral glucose tolerance test (OGTT) results, improvements in fat and fibre intakes, increased level of engagement in physical activity and reduction in diabetes incidence. Results Twelve from 41 potentially relevant studies were included in the review. Four studies were suitable for meta-analysis. A significant positive effect of the interventions on weight was reported by all study types. The meta-analysis showed that lifestyle interventions achieved weight and waist circumference reductions after one year. However, no clear effects on biochemical or clinical parameters were observed, possibly due to short follow-up periods or lack of power of the studies meta-analysed. Changes in dietary parameters or physical activity were generally not reported. Most studies assessing feasibility were supportive of implementation of lifestyle interventions in routine clinical care. Conclusion Lifestyle interventions for patients at high risk of diabetes, delivered by a variety of healthcare providers in routine clinical settings, are feasible but appear to be of limited clinical benefit one year after intervention. Despite convincing evidence from structured intensive trials, this systematic review showed that translation into routine practice has less effect on diabetes risk reduction.
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Blackwell CS, Foster KA, Isom S, Katula JA, Vitolins MZ, Rosenberger EL, Goff DC. Healthy Living Partnerships to Prevent Diabetes: recruitment and baseline characteristics. Contemp Clin Trials 2010; 32:40-9. [PMID: 20974289 DOI: 10.1016/j.cct.2010.10.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 10/08/2010] [Accepted: 10/15/2010] [Indexed: 11/15/2022]
Abstract
Healthy Living Partnerships to Prevent Diabetes (HELP PD) is a randomized controlled trial designed to translate the Diabetes Prevention Program (DPP) lifestyle intervention into a community setting using community health workers engaged through an existing Diabetes Care Center (DCC). Overweight and obese (BMI 25-40 kg/m²) individuals with pre-diabetes (fasting blood glucose 95-125 mg/dl) with no medical contraindications to participate in a lifestyle intervention were recruited for participation in this study. Standard recruitment strategies were employed, including mass mailing, direct provider referral, and community events. Participant recruitment and randomization for this trial began in 2007 and was concluded in 2009. 1818 screenings were conducted; of these, 326 (17.9%) qualified and 301 (16.6%) participants were randomized over a 21 month period. 23.8% of potential participants were excluded during the initial telephone screening, primarily for BMI and recent history of CVD. The majority of participants (220, 73.1%) reported mass mailing as their primary source of information about the study. Mass mailing was more effective with participants who identified themselves as white when compared to African-Americans. The cost of recruitment per randomized participant was $816, which includes direct costs and staff effort. 41% of the randomized participants were male and approximately 27% reported a race or ethnicity other than white. In comparison to the DPP study cohort, the HELP PD population is older, more educated and predominately white. These differences, reflecting in part the community in which HELP PD was conducted, may have implications for retention and adherence in the lifestyle intervention group.
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Affiliation(s)
- Caroline S Blackwell
- Wake Forest University School of Medicine, Division of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Weight loss following a clinic-based weight loss program among adults with attention deficit/hyperactivity disorder symptoms. Eat Weight Disord 2010; 15:e166-72. [PMID: 21150252 PMCID: PMC3211042 DOI: 10.1007/bf03325296] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to compare obese patients screening positive or negative for attention deficit/hyperactivity disorder (ADHD) on pretreatment body mass index (BMI), weight loss following a 16 week clinic-based behavioral weight loss program, weight loss attempts, dietary and physical activity habits, perceived difficulty of weight control skills, and eating self-efficacy. DESIGN Patients who completed a behavioral weight loss program were approached to complete questionnaires on ADHD and eating habits. Medical charts were reviewed to obtain weight at pre- and post-treatment. RESULTS Participants (N=63) were 75% female, mean age was 49 (SD=10.3), mean body mass index (BMI) was 41.4 kg/m² (SD=6.8) and 30% screened positive for ADHD on the Adult ADHD Symptom Rating Scale. Participants screening positive for ADHD did not have a higher BMI at baseline (p=0.41), but reported more previous weight loss attempts (p=0.01) and lost less weight (p=0.02) than participants who screened negative. Participants screening positive also reported consuming fast food meals more frequently (p=0.04), higher levels of emotional eating (p=0.002), greater difficulty with weight control skills (p=0.01), and lower eating self-efficacy (p=0.001). CONCLUSION Attention-related problems appear to be common among weight treatment-seeking samples and represent a significant barrier to weight control that has not yet been addressed in the literature.
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Delgadillo AT, Grossman M, Santoyo-Olsson J, Gallegos-Jackson E, Kanaya AM, Stewart AL. Description of an academic community partnership lifestyle program for lower income minority adults at risk for diabetes. THE DIABETES EDUCATOR 2010; 36:640-50. [PMID: 20576836 PMCID: PMC3771540 DOI: 10.1177/0145721710374368] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Translating strategies and approaches from the successful clinically based Diabetes Prevention Program's lifestyle intervention to community settings is a key next step. This article describes a lifestyle program developed in partnership by researchers at a major university and public health professionals at a local health department. METHODS The Live Well, Be Well (LWBW) program was designed to meet the needs of lower income, minority, and low-literacy adults at risk for diabetes. It was adapted from interventions with demonstrated efficacy and delivered in Spanish and English by health department staff. The program consisted of a 6-month active phase and a 6-month maintenance phase and was primarily telephone based, with one in-person planning session and several group workshops. In-person and group sessions were held in convenient community-based settings. Counselors provided education and skills training to modify diet and increase physical activity. Self-selected and attainable goal-setting and action plans were emphasized to enhance self-efficacy. LWBW is the intervention component of a randomized trial with primary outcomes of fasting glucose, weight, and other clinical measures. CONCLUSIONS The program provides a unique translational model for implementing diabetes risk reduction programs for underserved populations. Individually tailored and nonprescriptive, it utilized existing health department infrastructure, focused on telephone counseling, used culturally appropriate, low-literacy materials, and was delivered in local, community-based facilities.
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Affiliation(s)
- Adriana T. Delgadillo
- University of California San Francisco, Institute for Health & Aging, 3333 California St. Suite 340, San Francisco, CA 94118, Phone: 650 278-2504, Fax: 415 502-5208
| | - Melanie Grossman
- University of California San Francisco, Institute for Health & Aging, 3333 California St. Suite 340, San Francisco, CA 94118, Phone: 415 923-0850, Fax: 415 502-5208
| | - Jasmine Santoyo-Olsson
- University of California San Francisco, Institute for Health & Aging, 3333 California St. Suite 340, San Francisco, CA 94118, Phone: 415 502-1690, Fax: 415 502-5208
| | - Elisa Gallegos-Jackson
- City of Berkeley Division of Public Health, 1947 Center Street, 2nd floor, Berkeley, CA 94710, Phone: 510-981-5317, Fax: 510-981-5345
| | - Alka M. Kanaya
- University of California, San Francisco, Division of General Internal Medicine, School of Medicine, 1635 Divisadero Street, Suite 515, San Francisco, CA 94115, Phone: 415-353-9753, FAX: 415-353-9856
| | - Anita L. Stewart
- University of California San Francisco, Institute for Health & Aging, 3333 California St. Suite 340, San Francisco, CA 94118, Phone: 415 502-5207, Fax: 415 502-5208
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Mau MK, Keawe'aimoku Kaholokula J, West MR, Leake A, Efird JT, Rose C, Palakiko DM, Yoshimura S, Kekauoha PB, Gomes H. Translating diabetes prevention into native Hawaiian and Pacific Islander communities: the PILI 'Ohana Pilot project. Prog Community Health Partnersh 2010; 4:7-16. [PMID: 20364073 DOI: 10.1353/cpr.0.0111] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Native Hawaiians (NH) and Other Pacific Islanders (OPI) bear an excess burden of diabetes health disparities. Translation of empirically tested interventions such as the Diabetes Prevention Program Lifestyle Intervention (DPP-LI) offers the potential for reversing these trends. Yet, little is known about how best to translate efficacious interventions into public health practice, particularly among racial/ethnic minority populations. Community-based participatory research (CBPR) is an approach that engages the community in the research process and has recently been proposed as a means to improve the translation of research into community practice. OBJECTIVES To address diabetes health disparities in NHOPIs, CBPR approaches were used to: (1) culturally adapt the DPP-LI for NHOPI communities; and (2) implement and examine the effectiveness of the culturally-adapted program to promote weight loss in 5 NHOPI communities. METHODS Informant interviews (n=15) and focus groups (n=15, with 112 NHOPI participants) were completed to inform the cultural adaptation of the DPP-LI program. A team of 5 community investigators and 1 academic research team collaboratively developed and implemented the 12-week pilot study to assess the effectiveness of the culturally adapted program. RESULTS A total of 127 NHOPIs participated in focus groups and informant interviews that resulted in the creation of a significantly modified version of the DPP-LI, entitled the PILI 'Ohana Lifestyle Intervention (POLI). In the pilot study, 239 NHOPIs were enrolled and after 12 weeks (post-program), mean weight loss was -1.5 kg (95%CI -2.0, -1.0) with 26% of participants losing > or = 3% of their baseline weight. Mean weight loss among participants who completed all 8 lessons at 12 weeks was significantly higher (-1.8 kg, 95%CI -2.3, -1.3) than participants who completed less than 8 lessons (-0.70 kg, 95%CI -1.1, -0.29). CONCLUSION A fully engaged CBPR approach was successful in translating an evidence based diabetes prevention program into a culturally relevant intervention for NHOPI communities. This pilot study demonstrates that weight loss in high risk minority populations can be achieved over a short period of time using CBPR approaches.
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Affiliation(s)
- Marjorie K Mau
- University of Hawai'i, Center for Native and Pacific Health Disparities Research, Department of Native Hawaiian Health, John A. Burns School of Medicine
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Nutritional intervention programme among a Japanese-Brazilian community: procedures and results according to gender. Public Health Nutr 2010; 13:1453-61. [DOI: 10.1017/s1368980010000935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo describe the results of a nutritional intervention programme among Japanese-Brazilians according to gender.DesignA non-controlled experimental study.SettingThe research included three points of clinical, nutritional and physical activity evaluation: at baseline (in 2005), after the first year and at the end of the second year (in 2007). The paired Student t test and multiple linear regression analysis were used to evaluate changes in the subjects’ profile (clinical, nutritional and physical activity variables).SubjectsJapanese-Brazilians (n 575) of both genders, aged over 30 years.ResultsWe verified statistically significant reductions in body weight (0·9 kg), waist circumference (2·9 cm), blood pressure, fasting blood glucose (>3 mg/dl) and total cholesterol (>20 mg/dl) and its fractions, in both genders. We also found reductions in intake of energy (among men), protein (among women) and fat (both genders) and increases in intake of total fibre (among women) and carbohydrate (among men).ConclusionsThe intervention programme indicated meaningful benefits for the intervention subjects, with changes in their habits that led to a ‘healthier’ lifestyle positively impacting their nutritional and metabolic profile.
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Vadheim LM, Brewer KA, Kassner DR, Vanderwood KK, Hall TO, Butcher MK, Helgerson SD, Harwell TS. Effectiveness of a Lifestyle Intervention Program Among Persons at High Risk for Cardiovascular Disease and Diabetes in a Rural Community. J Rural Health 2010; 26:266-72. [DOI: 10.1111/j.1748-0361.2010.00288.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bersoux S, Asbury KL, Cook CB, Verheijde JL, Larson MH, Aponte-Furlow RT, Flatten SS, Hooley SA, LaRosa CS, Seifert KM, Verona PM, Castro JC, Jameson KA. An outpatient-based clinical program for type 2 diabetes prevention. Endocr Pract 2010; 16:21-9. [PMID: 19703810 DOI: 10.4158/ep09151.or] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review first-year results of a clinic-based type 2 diabetes prevention program. METHODS From January through December 2007, patients with a diagnosis of prediabetes participated in the Diet-Exercise-Activity-Lifestyle program for instruction in lifestyle changes. Physical therapy assessments were retrospectively reviewed to search for symptoms or findings of physical impairments. Changes in weight and 2-hour glucose tolerance test results were assessed at 6 months. Patient satisfaction with the program was evaluated. RESULTS Ninety-two patients qualified for the program. Mean baseline fasting glucose concentration was 108 mg/dL, and 2-hour glucose concentration was 134 mg/dL. Mean age was 62 years, and 66% were women. Review of physical therapy assessments demonstrated gait/balance disturbances in 47% of patients, peripheral neuropathy in 43%, and musculoskeletal problems in 63%. Among 47 patients who had 6-month follow-up visits, 72% lost weight. Fasting glucose levels improved in 58% in persons with impaired fasting glucose, and 2-hour glucose values decreased in patients who had impaired glucose tolerance. Seventy-eight percent graded the program as either "very good" or "excellent." CONCLUSIONS Programs geared toward type 2 diabetes prevention can be feasibly implemented on an outpatient basis. Preliminary data suggest that improvements in weight and glucose values can be achieved. As the prevalence of prediabetes increases, health care systems must gain further experience with effective outpatient diabetes prevention strategies.
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Affiliation(s)
- Sophie Bersoux
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona 85259, USA.
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