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Richards R, Wren GM, Campion P, Whitman M. A Remotely Delivered, Semaglutide-Supported Specialist Weight Management Program: Preliminary Findings From a Retrospective Service Evaluation. JMIR Form Res 2023; 7:e53619. [PMID: 38153780 PMCID: PMC10784980 DOI: 10.2196/53619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Digital weight management interventions have the potential to increase access to novel pharmacotherapy for people living with obesity. At present, there is limited real-world evidence on the effectiveness, feasibility, and acceptability of this type of intervention. OBJECTIVE This retrospective service evaluation examines real-world data to evaluate the preliminary impact of Second Nature's 24-month, remotely delivered, semaglutide-supported weight management intervention for adults living with obesity at 12 weeks. METHODS Retrospective data were extracted in October 2023 for participants who started the intervention between June 8, 2023, and July 22, 2023. The primary outcomes were weight change (kg) and percentage of weight change at 12 weeks. The secondary outcomes were the proportion of participants who achieved ≥5% and ≥10% weight loss and the feasibility and acceptability of this type of intervention. Descriptive statistics were used to evaluate the baseline characteristics, retention, engagement, prevalence of side effects, and weight change. A paired 2-tailed t test was used to determine the significance of weight change. Content analysis was used to analyze the free-text questionnaire responses. RESULTS A total of 113 participants with a mean baseline BMI of 38.4 kg/m2 (SD 7.3) were included in the analysis (n=102, 90.4% women, mean age 46.6, SD 11.1 years). Over 12 weeks, 23% (n=26) of participants withdrew from the intervention. A total of 70.8% (n=80) of participants provided weight data at 12 weeks. The average weight loss observed over this 12-week period was 6.5 (SD 4.4) kg (P<.001) or 6.4% (SD 4.2%) of their starting weight (P<.001). Of the 80 participants who recorded weight readings, 62.5% (n=50) achieved ≥5% weight loss, and 11.3% (n=9) achieved ≥10% weight loss. Engagement with the app-based program declined from a mean of 131 (SD 142.6) home screen views in week 0 to 35 (SD 57.1) in week 11. Common side effects reported over 12 weeks included feeling more tired than usual, constipation, and feeling sick. However, a significant proportion of participants reported no side effects. Most participants (n=106, 93.8%) did not experience any difficulties in medication administration. Qualitative data showed that most participants had a positive or neutral experience of the intervention, with some reporting perceived benefits as early as 4 weeks. Most participants did not feel that improvements in the intervention were needed; however, some participants faced issues with medication shipping or logistics. CONCLUSIONS This retrospective preliminary service evaluation suggests that a remotely delivered semaglutide-supported weight management intervention has the potential to be effective, feasible, and acceptable for self-paying consumer adults with obesity in the United Kingdom. Areas for further improvement were highlighted, including user engagement in an app-based program. A full-service evaluation at the end of the 24-month intervention with a larger sample size is required to support these early findings.
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Affiliation(s)
| | - Gina M Wren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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2
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Pérez-Beltrán YE, González-Becerra K, Rivera-Iñiguez I, Martínez-López E, Ramos-Lopez O, Alcaraz-Mejía M, Rodríguez-Echevarría R, Sáyago-Ayerdi SG, Mendivil EJ. A Nutrigenetic Strategy for Reducing Blood Lipids and Low-Grade Inflammation in Adults with Obesity and Overweight. Nutrients 2023; 15:4324. [PMID: 37892400 PMCID: PMC10609523 DOI: 10.3390/nu15204324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
The pathogenesis of obesity and dyslipidemia involves genetic factors, such as polymorphisms related to lipid metabolism alterations predisposing their development. This study aimed to evaluate the effect of a nutrigenetic intervention on the blood lipid levels, body composition, and inflammation markers of adults with obesity and overweight. Eleven genetic variants associated with dyslipidemias in Mexicans were selected, and specific nutrigenetic recommendations for these polymorphisms were found. One hundred and one adults were recruited and assigned to follow either a standard or nutrigenetic diet for eight weeks. Anthropometric, biochemical, body composition, and inflammation markers were evaluated through standardized methods. Weighted genetic risk scores (wGRSs) were computed using the study polymorphisms. After intervention, both diets significantly decreased the anthropometric parameters and body composition (p < 0.05). Only the nutrigenetic diet group showed significant reductions in VLDL-c (p = 0.001), triglycerides (p = 0.002), TG:HDL (p = 0.002), IL-6 (p = 0.002), and TNF-α (p = 0.04). wGRSs had a high impact on the ΔTGs and ΔVLDL-c of both groups (standard diet: ΔTGs: Adj R2 = 0.69, p = 0.03; ΔVLDL-c: Adj R2 = 0.71, p = 0.02; nutrigenetic diet: ΔTGs: Adj R2 = 0.49, p = 0.03 and ΔVLDL-c: R2 = 0.29, p = 0.04). This nutrigenetic intervention improved lipid abnormalities in patients with excessive body weight. Hence, nutrigenetic strategies could be coadjuvant tools and enhance the standard dietary treatment for cardiometabolic diseases.
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Affiliation(s)
- Yolanda E. Pérez-Beltrán
- Laboratorio Integral de Investigación en Alimentos, Tecnológico Nacional de México/Instituto Tecnológico de Tepic, Tepic 63175, Nayarit, Mexico;
| | - Karina González-Becerra
- Departamento de Ciencias Médicas y de la Vida, Centro Universitario de la Ciénega, Instituto de Investigación en Genética Molecular, Universidad de Guadalajara, Ocotlán 47820, Jalisco, Mexico;
| | - Ingrid Rivera-Iñiguez
- Department of Pediatrics, University of California, UCSD Center for Healthy Eating and Activity Research (CHEAR), San Diego, CA 92037, USA;
| | - Erika Martínez-López
- Instituto de Nutrigenética y Nutrigenómica Traslacional, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico; (E.M.-L.); (R.R.-E.)
| | - Omar Ramos-Lopez
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana 22390, Baja California, Mexico;
| | - Mildreth Alcaraz-Mejía
- Departamento de Electrónica, Sistemas e Informática, ITESO, Unioversidad Jesuita de Guadalajara, Tlaquepaque 45604, Jalisco, Mexico;
| | - Roberto Rodríguez-Echevarría
- Instituto de Nutrigenética y Nutrigenómica Traslacional, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico; (E.M.-L.); (R.R.-E.)
| | - Sonia G. Sáyago-Ayerdi
- Laboratorio Integral de Investigación en Alimentos, Tecnológico Nacional de México/Instituto Tecnológico de Tepic, Tepic 63175, Nayarit, Mexico;
| | - Edgar J. Mendivil
- Departamento de Salud, Universidad Iberoamericana, Ciudad de Mexico 01219, Mexico
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3
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Mitchell ES, Fabry A, Ho AS, May CN, Baldwin M, Blanco P, Smith K, Michaelides A, Shokoohi M, West M, Gotera K, El Massad O, Zhou A. The Impact of a Digital Weight Loss Intervention on Health Care Resource Utilization and Costs Compared Between Users and Nonusers With Overweight and Obesity: Retrospective Analysis Study. JMIR Mhealth Uhealth 2023; 11:e47473. [PMID: 37616049 PMCID: PMC10485704 DOI: 10.2196/47473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/15/2023] [Accepted: 07/12/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The Noom Weight program is a smartphone-based weight management program that uses cognitive behavioral therapy techniques to motivate users to achieve weight loss through a comprehensive lifestyle intervention. OBJECTIVE This retrospective database analysis aimed to evaluate the impact of Noom Weight use on health care resource utilization (HRU) and health care costs among individuals with overweight and obesity. METHODS Electronic health record data, insurance claims data, and Noom Weight program data were used to conduct the analysis. The study included 43,047 Noom Weight users and 14,555 non-Noom Weight users aged between 18 and 80 years with a BMI of ≥25 kg/m² and residing in the United States. The index date was defined as the first day of a 3-month treatment window during which Noom Weight was used at least once per week on average. Inverse probability treatment weighting was used to balance sociodemographic covariates between the 2 cohorts. HRU and costs for inpatient visits, outpatient visits, telehealth visits, surgeries, and prescriptions were analyzed. RESULTS Within 12 months after the index date, Noom Weight users had less inpatient costs (mean difference [MD] -US $20.10, 95% CI -US $30.08 to -US $10.12), less outpatient costs (MD -US $124.33, 95% CI -US $159.76 to -US $88.89), less overall prescription costs (MD -US $313.82, 95% CI -US $565.42 to -US $62.21), and less overall health care costs (MD -US $450.39, 95% CI -US $706.28 to -US $194.50) per user than non-Noom Weight users. In terms of HRU, Noom Weight users had fewer inpatient visits (MD -0.03, 95% CI -0.04 to -0.03), fewer outpatient visits (MD -0.78, 95% CI -0.93 to -0.62), fewer surgeries (MD -0.01, 95% CI -0.01 to 0.00), and fewer prescriptions (MD -1.39, 95% CI -1.76 to -1.03) per user than non-Noom Weight users. Among a subset of individuals with 24-month follow-up data, Noom Weight users incurred lower overall prescription costs (MD -US $1139.52, 95% CI -US $1972.21 to -US $306.83) and lower overall health care costs (MD -US $1219.06, 95% CI -US $2061.56 to -US $376.55) per user than non-Noom Weight users. The key differences were associated with reduced prescription use. CONCLUSIONS Noom Weight use is associated with lower HRU and costs than non-Noom Weight use, with potential cost savings of up to US $1219.06 per user at 24 months after the index date. These findings suggest that Noom Weight could be a cost-effective weight management program for individuals with overweight and obesity. This study provides valuable evidence for health care providers and payers in evaluating the potential benefits of digital weight loss interventions such as Noom Weight.
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Affiliation(s)
| | - Alexander Fabry
- Academic Research, Noom, Inc, New York City, NY, United States
| | - Annabell Suh Ho
- Academic Research, Noom, Inc, New York City, NY, United States
| | - Christine N May
- Academic Research, Noom, Inc, New York City, NY, United States
| | - Matthew Baldwin
- Academic Research, Noom, Inc, New York City, NY, United States
| | - Paige Blanco
- Academic Research, Noom, Inc, New York City, NY, United States
| | - Kyle Smith
- Academic Research, Noom, Inc, New York City, NY, United States
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4
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Rivera-Íñiguez I, González-Becerra K, Ramos-Lopez O, Peréz-Beltrán YE, Chagüén-Hernández MS, Martínez-López E, Mendivil EJ. Lipid-Related Genetic Variants for Personalized Dietary Interventions: A Systematic Review. Mol Nutr Food Res 2023; 67:e2200675. [PMID: 37186438 DOI: 10.1002/mnfr.202200675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/26/2023] [Indexed: 05/17/2023]
Abstract
Dyslipidemias are known risk factors for chronic diseases. Precision nutrition interventions are designed according to characteristics, such as diet, phenotype, and genotype. This systematic review aims to define a panel of genetic variants associated with lipid abnormalities that could be later used in nutrigenetic intervention studies. A systematic review is conducted following the PRISMA-P. Studies published from January 2010 to December 2020 in English language and humans are included from PubMed and ScienceDirect databases. Articles that demonstrate a strong association between polymorphisms (single nucleotide variation) of genes involved in lipid metabolism and increased risk for dyslipidemia are included. A total of 3031 articles are screened, but only 51 articles fulfill the inclusion criteria. The genes included are FABP2, MTTP related to CM synthesis and secretion; LPL, LIPC involved in triglyceride hydrolysis; CETP, APOA1, LCAT, ABCA1, and APOA5 related to lipoprotein metabolism, and APOE, LDLR, SCARB1, APOC3 involved in lipid clearance. In this systematic review, genetic variants related to chylomicron synthesis, triglyceride hydrolysis, lipoprotein metabolism, and lipid clearance demonstrate a strong association with lipid abnormalities, which can be used to design precision nutrition interventions that may help to prevent and treat dyslipidemia effectively.
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Affiliation(s)
- Ingrid Rivera-Íñiguez
- Grupo de Investigación en Nutrición y Ciencias de los Alimentos, Departamento de Psicología, Educación y Salud, ITESO, Universidad Jesuita de Guadalajara, Guadalajara, 45604, México
- Departamento de Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Karina González-Becerra
- Departamento de Ciencias Médicas y de la Vida, Centro Universitario de la Ciénega, Instituto de Investigación en Genética Molecular, Universidad de Guadalajara, Ocotlán, Jalisco, 47820, México
| | - Omar Ramos-Lopez
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, Baja California, 22390, México
| | - Yolanda E Peréz-Beltrán
- Laboratorio Integral de Investigación en Alimentos, Instituto Tecnológico de Tepic/Instituto Nacional de México, Tepic, Nayarit, 63175, México
| | - Marian S Chagüén-Hernández
- Grupo de Investigación en Nutrición y Ciencias de los Alimentos, Departamento de Psicología, Educación y Salud, ITESO, Universidad Jesuita de Guadalajara, Guadalajara, 45604, México
| | - Erika Martínez-López
- Instituto de Nutrigenética y Nutrigenómica Traslacional, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Edgar J Mendivil
- Grupo de Investigación en Nutrición y Ciencias de los Alimentos, Departamento de Psicología, Educación y Salud, ITESO, Universidad Jesuita de Guadalajara, Guadalajara, 45604, México
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, 01219, México
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5
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Thompson DA, Haemer MA, Krebs NF, Pereira RI, Moss A, Furniss AL, Bonczynski J, Nicklas JM. A WIC-Based Behavior Change Intervention for Postpartum Women With Overweight and Obesity: A Pilot Feasibility Randomized Trial. Health Promot Pract 2023:15248399231173704. [PMID: 37226873 PMCID: PMC10674029 DOI: 10.1177/15248399231173704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Background. Postpartum weight retention is a risk factor for obesity and is particularly important among Hispanic women who have an increased rate of obesity. Given its broad reach, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program provides an ideal setting to implement community-based interventions for low-income postpartum women. Purpose. To examine the feasibility, acceptability, and preliminary efficacy of a multicomponent intervention delivered by staff within the WIC program designed to promote behavior changes in urban, postpartum women with overweight/obesity. Method. This was a 12-week pilot trial randomizing participants to a health behavior change (Intervention) or control (Observation) group. The Intervention included monthly visits with trained WIC staff providing patient-centered behavior change counseling, with multiple touchpoints between visits promoting self-monitoring and offering health behavior change support. Results. Participants (n = 41), who were mainly Hispanic (n = 37, 90%) and Spanish-speaking (n = 33, 81%), were randomized to the Intervention (n = 19) or Observation (n = 22) group. In the Intervention group, 79% (n = 15) of eligible participants were retained for the study duration. All Intervention participants endorsed that they would participate again. Regarding physical activity, participant readiness to change and self-efficacy improved for Intervention participants. About one-quarter of women in the Intervention group (27%, n = 4) had a 5% weight loss compared with one woman (5%) in the Observation group; this difference was not statistically significant (p = .10). Conclusions. This pilot demonstrated the feasibility and acceptability of delivering a low-intensity behavior change intervention within the WIC setting for postpartum women with overweight/obesity. Findings support the role of WIC in addressing postpartum obesity.
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Affiliation(s)
- Darcy A Thompson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Matthew A Haemer
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Nancy F Krebs
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Rocio I Pereira
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Angela Moss
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Anna L Furniss
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Jacinda M Nicklas
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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6
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Tham KW, Abdul Ghani R, Cua SC, Deerochanawong C, Fojas M, Hocking S, Lee J, Nam TQ, Pathan F, Saboo B, Soegondo S, Somasundaram N, Yong AML, Ashkenas J, Webster N, Oldfield B. Obesity in South and Southeast Asia-A new consensus on care and management. Obes Rev 2023; 24:e13520. [PMID: 36453081 PMCID: PMC10078503 DOI: 10.1111/obr.13520] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022]
Abstract
Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.
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Affiliation(s)
- Kwang Wei Tham
- Singapore Association for the Study of Obesity, Singapore
| | | | - Sioksoan C Cua
- Division of Pediatric Endocrinology, Philippine General Hospital, Metro Manila, Philippines.,Department of Pediatrics, Chinese General Hospital, Cardinal Santos Medical Center, Manila Doctors Hospital, Metro Manila, Philippines
| | | | - Mia Fojas
- Department of Biochemistry and Molecular Biology, University of the Philippines College of Medicine, Manila, Philippines
| | - Samantha Hocking
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - June Lee
- Upper Gastrointestinal and Bariatric Surgery, Department of Surgery, Changi General Hospital, Singapore
| | - Tran Quang Nam
- Department of Endocrinology, Ho Chi Minh City University Medical Center, Ho Chi Minh City, Vietnam
| | - Faruque Pathan
- Department of Endocrinology, Ibrahim Memorial Diabetes Center, Dhaka, Bangladesh
| | - Banshi Saboo
- Dia Care Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Sidartawan Soegondo
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.,Diabetes Connection and Care, Eka Hospitals, Jakarta, Indonesia
| | | | - Alice M L Yong
- Department of Internal Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | | | - Brian Oldfield
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia
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7
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Zhu L, Kim EJ, González E, Fraser MA, Zhu S, Rubio-Torio N, Ma GX, Yeh MC, Tan Y. Reducing Liver Cancer Risk through Dietary Change: Positive Results from a Community-Based Educational Initiative in Three Racial/Ethnic Groups. Nutrients 2022; 14:4878. [PMID: 36432564 PMCID: PMC9698707 DOI: 10.3390/nu14224878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Dietary behaviors and alcohol consumption have been linked to liver disease and liver cancer. So far, most of the liver cancer awareness campaigns and behavioral interventions have focused on preventive behaviors such as screening and vaccination uptake, while few incorporated dietary aspects of liver cancer prevention. We implemented a community-based education initiative for liver cancer prevention among the African, Asian, and Hispanic populations within the Greater Philadelphia and metropolitan New York City areas. Data from the baseline and the 6-month follow-up surveys were used for the assessment of changes in dietary behaviors and alcohol consumption among participants. In total, we recruited 578 participants through community-/faith-based organizations to participate in the educational workshops. The study sample included 344 participants who completed both baseline and follow-up survey. The Hispanic subgroup was the only one that saw an overall significant change in dietary behaviors, with the Mediterranean dietary score increasing significantly from 30.000 at baseline survey to 31.187 at 6-month follow-up assessment (p < 0.05), indicating a trend towards healthier dietary habit. In the African Americans participants, the consumption scores of fruits and poultry increased significantly, while vegetables and red meats decreased. In Asian Americans, the consumption of non-refined cereals, red meats, and dairy products decreased. Alcohol consumption decreased significantly among Hispanics while it did not change significantly among the other two communities. This community-based educational initiative generated different impacts in the three populations, further highlighting the needs for more targeted, culturally tailored efforts in health promotion among these underprivileged communities.
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Affiliation(s)
- Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Ellen Jaeseon Kim
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Evelyn González
- Office of Community Outreach, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, USA
| | | | - Steven Zhu
- Pennsylvania United Chinese Coalition, Philadelphia, PA 19107, USA
| | | | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, New York, NY 10017, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
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8
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Chen J, Kaur H, Jaques J, Rock Z, Dean CM, Lord RV, Preda V. Association of clinically significant weight loss with number of patient visits and months of attendance at an Australian multidisciplinary weight management clinic. Clin Obes 2022; 12:e12520. [PMID: 35343053 PMCID: PMC9285583 DOI: 10.1111/cob.12520] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/06/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
Despite the obesity epidemic, there are relatively few multidisciplinary obesity services in Australia, and only limited data on the effectiveness of these services. The aim of this study was to evaluate the effectiveness of a university hospital-based weight management clinic-the 'Healthy Weight Clinic' in supporting patients to achieve clinically significant weight loss (≥5% reduction in body weight), weight maintenance, and changes in body composition. A retrospective review was conducted to determine weight and associated health outcomes in patients who attended an initial consultation in the first 2 years of the clinic-between March 2017 and March 2019. Follow up was at least 1 year for all patients. Patients who underwent bariatric surgery were excluded. Of 213 total patients, 172 patients attended more than one follow-up consultation for lifestyle modification. Mean weight change and percentage total weight change at last follow-up was -6.2 kg (SD 7.4) and - 6.0% (SD 6.9), respectively. For every additional clinic follow-up, there was 21.4% increased odds of achieving clinically significant weight loss, and for every additional month of follow-up, there was 10.1% increased odds of achieving clinically significant weight loss. Twenty percent of patients (34/172) maintained ≥5% of initial body weight loss for at least 1 year. Body composition measurements were also favourable, with significant changes in percentage skeletal muscle mass of +0.8% (SD 1.5) and in percentage fat mass by -1.4% (SD 3.2). Regular support in a structured holistic multidisciplinary obesity service enables patients to achieve clinically meaningful weight loss and improved skeletal muscle mass to body fat ratio, and maintain this loss for at least 1 year. Improved weight loss was associated with more patient visits and longer duration of attendance at the clinic.
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Affiliation(s)
- Juliana Chen
- Healthy Weight Clinic, MQ HealthMacquarie University HospitalSydneyNew South WalesAustralia
- Department of Clinical Medicine, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, Charles Perkins CentreThe University of SydneyCamperdownNew South WalesAustralia
| | - Harpreet Kaur
- Department of Clinical Medicine, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Joanna Jaques
- Healthy Weight Clinic, MQ HealthMacquarie University HospitalSydneyNew South WalesAustralia
- Department of Clinical Medicine, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Zoe Rock
- Department of Clinical Medicine, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Catherine M. Dean
- Department of Health Sciences, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Reginald V. Lord
- Healthy Weight Clinic, MQ HealthMacquarie University HospitalSydneyNew South WalesAustralia
- Department of Surgery, School of MedicineUniversity of Notre DameSydneyNew South WalesAustralia
| | - Veronica Preda
- Healthy Weight Clinic, MQ HealthMacquarie University HospitalSydneyNew South WalesAustralia
- Department of Clinical Medicine, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
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9
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Wong SH, Tan ZYA, Cheng LJ, Lau ST. Wearable technology-delivered lifestyle intervention amongst adults with overweight and obese: A systematic review and meta-regression. Int J Nurs Stud 2021; 127:104163. [DOI: 10.1016/j.ijnurstu.2021.104163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/08/2023]
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10
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Effect of Acupuncture on Simple Obesity and Serum Levels of Prostaglandin E and Leptin in Sprague-Dawley Rats. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:6730274. [PMID: 34646336 PMCID: PMC8505091 DOI: 10.1155/2021/6730274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Abstract
Aim The study is aimed at investigating the curative effect of acupuncture on simple obesity and its influence on serum levels of prostaglandin E and leptin in Sprague-Dawley (SD) rats. Methods In the study, there are 50 male SD rats. We took 10 as healthy controls and fed 40 with a diet of high fat for 8 weeks. After the 40 rat model was established successfully, we fed 10 rats in the model group with a normal diet and treated 10 rats in the acupuncture group by acupuncture. During the experiment, the body fat and body length of rats were measured weekly, and Lee's index was calculated. After the treatment, the levels of leptin, prostaglandin E, C-reactive protein (CRP), triacylglycerol (TG), cholesterol (CHO), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were detected, and the liver fat morphology was observed by electron microscope. Results Acupuncture significantly downregulated the serum levels of CRP, TG, CHO, LDL, leptin, and prostaglandin E and upregulated the serum levels of HDL in rats with simple obesity. Conclusion On basis of these results, it was found that acupuncture could boost fat metabolism and weight loss by inhibiting the production of leptin and prostaglandin E.
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11
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Hawa F, Gladshteyn M, Gunaratnam SV, Scheidel C, Corsello PM, Berger SH, Gunaratnam NT. Effective Treatment of Nonalcoholic Fatty Liver Disease Using a Community-Based Weight Management Program. Cureus 2021; 13:e16709. [PMID: 34466334 PMCID: PMC8399292 DOI: 10.7759/cureus.16709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Obesity-related gastrointestinal disorders including nonalcoholic fatty liver disease (NAFLD) and gastroesophageal reflux disease (GERD) are more frequent and usually present earlier than type 2 diabetes mellitus (T2DM) and cardiovascular disorders. This provides an opportunity for the gastroenterologist to intervene early with an effective weight-loss therapy. We evaluated the outcomes of a multifaceted, community-based gastroenterologist-supervised weight management program compared with patient-directed weight-loss efforts after physician advice. The program is aimed at achieving a 10% total body weight (TBW) loss at three months, a known determinant for NAFLD regression. Methods This is a retrospective pre- and post-intervention study of NAFLD patients, who participated in a medically supervised weight management program in the period between May 2017 and May 2019. The program is comprised of a very-low-calorie (800 kcal/day) meal replacement diet, a recommended medical fitness program, and weekly behavioral support groups. Patients are followed on monthly basis and slowly transitioned to a whole food plant-based or Mediterranean diet after three months of participation. Patients’ weight trends driven by self-directed efforts to lose weight after physician advice were collected based on historical data up to two years prior to program participation. The primary outcome was defined as percentage TBW loss at three months under medical supervision (post-intervention) compared with patient-directed weight-loss efforts (pre-intervention). The secondary outcomes included percentage TBW loss in relation to behavioral support group attendance and improvement in GERD and T2DM disease status after program participation. Linear mixed and linear regression models were used to assess for a statistically significant difference in percentage TBW loss. Statistical significance was defined as p < 0.05. Results A total of 114 NAFLD patients (mean age 55 years, mean BMI 39 kg/m2, 77 females, and 37 males) completed at least three months of follow-up and were included in the study. Of those, 89 patients had a documented three-month office visit. At three months, 65% of patients had lost at least 10% of their TBW. Percentage TBW loss under medical supervision was noted to be significantly higher and occurred at a faster rate over three months when compared with patient-directed efforts after physician advice (p < 0.001). Patients who attended the behavioral support groups ≥ 50% of the time had a 3% higher TBW loss at three months compared with patients who attended <50% of the time (p = 0.006). Approximately, 52% of patients with GERD and 38% of patients with T2DM had symptoms improvement and/or medication reduction at their three-month follow-up visit. Conclusion A multifaceted, community-based, gastroenterologist supervised weight management program is effective in achieving a clinically significant TBW loss of at least 10% within three months of participation. This weight loss was greater and occurred at a faster rate when compared with patient-directed efforts. Additionally, improvement in GERD and T2DM disease status was noted in 52% and 38% of patients with these conditions, respectively. Further community-based studies of a larger scale are needed to determine the sustainability of this weight loss over one year.
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Affiliation(s)
- Fadi Hawa
- Internal Medicine, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA.,Internal Medicine/Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA
| | - Mark Gladshteyn
- Internal Medicine/Gastroenterology and Hepatology, Huron Gastroenterology Associates, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
| | - Sejal V Gunaratnam
- Internal Medicine/Gastroenterology and Hepatology, Huron Gastroenterology Associates, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
| | - Caleb Scheidel
- Biostatistics, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
| | - Paul M Corsello
- Internal Medicine/Gastroenterology and Hepatology, Huron Gastroenterology Associates, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
| | - Stephen H Berger
- Internal Medicine/Gastroenterology and Hepatology, Huron Gastroenterology Associates, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
| | - Naresh T Gunaratnam
- Internal Medicine/Gastroenterology and Hepatology, Huron Gastroenterology Associates, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
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12
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Smit E, Leenaars K, Wagemakers A, van der Velden K, Molleman G. How to recruit inactive residents for lifestyle interventions: participants' characteristics based on various recruitment strategies. Health Promot Int 2021; 36:989-999. [PMID: 33270846 PMCID: PMC8521843 DOI: 10.1093/heapro/daaa134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Care Sport Connectors (CSCs) have been appointed to create a connection between primary care and physical activity (PA) sectors to stimulate inactive residents into becoming physically active. Adequate recruitment strategies are necessary to reach the intended target group in order to foster the sustainability of lifestyle interventions. The objective of this study is to explore PA behavior and health characteristics of the target group reached by CSCs and if these characteristics differ between participants when grouped based on how they were recruited. Participants from lifestyle interventions were included between September 2014 and April 2016 using a purposive sampling method. Participants were recruited through CSCs via public relations (n = 135), a personal letter (n = 136), or a referral (n = 98) and compared based on their PA level, health-related quality of life, motivation, self-efficacy, morbidity and health-related fitness. Scores were analyzed with a multi-level (mixed model) analysis measured before the intervention. The three groups were different in PA level (p = 0.002). The outcomes regarding health-related quality of life, motivation, and number of somatic disorders were also significantly different for the three groups, except for the categories of mental health (p = 0.145) and self-efficacy (p = 0.464). For all dimensions, the referral group scored the least favorable. The investment in time and money for an active recruitment strategy like referrals is worthwhile because it provides CSCs the opportunity to reach people who are inactive and at risk of chronic disease. Future studies are necessary to reveal the effect on PA levels and health in the long-term.
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Affiliation(s)
- Eva Smit
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
| | - Karlijn Leenaars
- Department of Healthy Living, RIVM,
Bilthoven, P.O Box 1, 3720 BA, The Netherlands
| | - Annemarie Wagemakers
- Social Sciences, Group Health & Society,
Wageningen University, Wageningen, P.O. Box 8130, 6700 EW,
The Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
| | - Gerard Molleman
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
- Research Department, GGD Gelderland
Zuid, Nijmegen, P.O. Box 1120, 6501 BC, The
Netherlands
- Corresponding author: E-mail:
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13
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A systematic review of the use of dietary self-monitoring in behavioural weight loss interventions: delivery, intensity and effectiveness. Public Health Nutr 2021; 24:5885-5913. [PMID: 34412727 DOI: 10.1017/s136898002100358x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify dietary self-monitoring implementation strategies in behavioural weight loss interventions. DESIGN We conducted a systematic review of eight databases and examined fifty-nine weight loss intervention studies targeting adults with overweight/obesity that used dietary self-monitoring. SETTING NA. PARTICIPANTS NA. RESULTS We identified self-monitoring implementation characteristics, effectiveness of interventions in supporting weight loss and examined weight loss outcomes among higher and lower intensity dietary self-monitoring protocols. Included studies utilised diverse self-monitoring formats (paper, website, mobile app, phone) and intensity levels (recording all intake or only certain aspects of diet). We found the majority of studies using high- and low-intensity self-monitoring strategies demonstrated statistically significant weight loss in intervention groups compared with control groups. CONCLUSIONS Based on our findings, lower and higher intensity dietary self-monitoring may support weight loss, but variability in adherence measures and limited analysis of weight loss relative to self-monitoring usage limits our understanding of how these methods compare with each other.
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14
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Yang Q, Mitchell ES, Ho AS, DeLuca L, Behr H, Michaelides A. Cross-National Outcomes of a Digital Weight Loss Intervention in the United States, Canada, United Kingdom and Ireland, and Australia and New Zealand: A Retrospective Analysis. Front Public Health 2021; 9:604937. [PMID: 34178911 PMCID: PMC8222510 DOI: 10.3389/fpubh.2021.604937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
Mobile health (mHealth) interventions are ubiquitous and effective treatment options for obesity. There is a widespread assumption that the mHealth interventions will be equally effective in other locations. In an initial test of this assumption, this retrospective study assesses weight loss and engagement with an mHealth behavior change weight loss intervention developed in the United States (US) in four English-speaking regions: the US, Australia and New Zealand (AU/NZ), Canada (CA), and the United Kingdom and Ireland (UK/IE). Data for 18,459 participants were extracted from the database of Noom's Healthy Weight Program. Self-reported weight was collected every week until program end (week 16). Engagement was measured using user-logged and automatically recorded actions. Linear mixed models were used to evaluate change in weight over time, and ANOVAs evaluated differences in engagement. In all regions, 27.2–33.2% of participants achieved at least 5% weight loss by week 16, with an average of 3–3.7% weight loss. Linear mixed models revealed similar weight outcomes in each region compared to the US, with a few differences. Engagement, however, significantly differed across regions (P < 0.001 on 5 of 6 factors). Depending on the level of engagement, the rate of weight loss over time differed for AU/NZ and UK/IE compared to the US. Our findings have important implications for the use and understanding of digital weight loss interventions worldwide. Future research should investigate the determinants of cross-country engagement differences and their long-term effects on intervention outcomes.
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Affiliation(s)
| | | | | | - Laura DeLuca
- Noom Inc., New York, NY, United States.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States
| | - Heather Behr
- Noom Inc., New York, NY, United States.,Department of Integrative Health, Saybrook University, Pasadena, CA, United States
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15
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McKenna CF, Salvador AF, Hughes RL, Scaroni SE, Alamilla RA, Askow AT, Paluska SA, Dilger AC, Holscher HD, De Lisio M, Khan NA, Burd NA. Higher protein intake during resistance training does not potentiate strength, but modulates gut microbiota, in middle-aged adults: a randomized control trial. Am J Physiol Endocrinol Metab 2021; 320:E900-E913. [PMID: 33682457 DOI: 10.1152/ajpendo.00574.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Protein intake above the recommended dietary allowance (RDA) and resistance training are known anabolic stimuli to support healthy aging. Specifically, protein supplementation after resistance exercise and nightly are strategies to maximize utilization of protein intake above the RDA in healthy adults. As such, the primary objective was to examine the efficacy of protein supplementation and nutritional counseling resulting in either moderate (MOD: ∼1.0 g·kg-1·day-1) or higher (HIGH: ∼1.6 g·kg-1·day-1) protein intake during resistance training on strength (one-repetition maximum, 1-RM; isokinetic and isometric peak torque) in healthy middle-aged adults. Exploratory analyses include diet-exercise effects on lean body mass (LBM), clinical biomarkers, gut microbiota, and diet composition. In all, 50 middle-aged adults (age: 50 ± 8 yr, BMI: 27.2 ± 4.1 kg/m2) were randomized to either MOD or HIGH protein intake during a 10-wk resistance training program (3 × wk). Participants received dietary counseling and consumed either 15 g (MOD) or 30 g (HIGH) of protein from lean beef in the immediate postexercise period and each evening. Maximal strength (1-RM) for all upper and lower body exercises significantly increased with no effect of protein intake (P < 0.050). There was a main effect of time for LBM (P < 0.005). Cardiovascular, renal, or glycemic biomarkers were not affected by the intervention. Gut microbiota were associated with several health outcomes (P < 0.050). In conclusion, higher protein intake above moderate amounts does not potentiate resistance training adaptations in previously untrained middle-aged adults. This trial was registered at clinicaltrials.gov as NCT03029975.NEW & NOTEWORTHY Our research evaluates the efficacy of higher in comparison with moderate animal-based protein intake on resistance exercise training-induced muscle strength, clinical biomarkers, and gut microbiota in middle-aged adults through a dietary counseling-controlled intervention. Higher protein intake did not potentiate training adaptations, nor did the intervention effect disease biomarkers. Both diet and exercise modified gut microbiota composition. Collectively, moderate amounts of high-quality, animal-based protein is sufficient to promote resistance exercise adaptations at the onset of aging.
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Affiliation(s)
- Colleen F McKenna
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Amadeo F Salvador
- Division of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Riley L Hughes
- Division of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Susannah E Scaroni
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Rafael A Alamilla
- Division of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Andrew T Askow
- Division of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Scott A Paluska
- Division of Family Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Anna C Dilger
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Hannah D Holscher
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Division of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Division of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Michael De Lisio
- School of Human Kinetics and Cellular and Molecular Medicine, University of Ottawa, Ontario, Canada
| | - Naiman A Khan
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Division of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Nicholas A Burd
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Division of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
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16
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Stubbs RJ, Duarte C, Palmeira AL, Sniehotta FF, Horgan G, Larsen SC, Marques MM, Evans EH, Ermes M, Harjumaa M, Turicchi J, O'Driscoll R, Scott SE, Pearson B, Ramsey L, Mattila E, Matos M, Sacher P, Woodward E, Mikkelsen ML, Sainsbury K, Santos I, Encantado J, Stalker C, Teixeira PJ, Heitmann BL. Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project. Obes Facts 2021; 14:320-333. [PMID: 33915534 PMCID: PMC8255638 DOI: 10.1159/000515663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. The Project: First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. IMPACT The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.
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Affiliation(s)
- R. James Stubbs
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Cristiana Duarte
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - António L. Palmeira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Graham Horgan
- Biomathematics and Statistics Scotland (James Hutton Institute), Aberdeen, United Kingdom
| | - Sofus C. Larsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Marta M. Marques
- Trinity Centre for Practice and Healthcare Innovation and ADAPT Centre, Trinity College Dublin, Dublin, Ireland
| | - Elizabeth H. Evans
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Miikka Ermes
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Marja Harjumaa
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Jake Turicchi
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Ruari O'Driscoll
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Sarah E. Scott
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Beth Pearson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Lauren Ramsey
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Elina Mattila
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Marcela Matos
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Paul Sacher
- Childhood Nutrition Research Centre, University College London, London, United Kingdom
| | - Euan Woodward
- European Association for the Study of Obesity, Teddington, United Kingdom
| | - Marie-Louise Mikkelsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Kirby Sainsbury
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Inês Santos
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Jorge Encantado
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Carol Stalker
- College of Life and Natural Sciences, University of Derby, Derby, United Kingdom
| | - Pedro J. Teixeira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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17
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The effect of a web-based psychoeducation on emotional functioning, eating behaviors, and body image among premenopausal women with excess body weight. Arch Womens Ment Health 2021; 24:423-435. [PMID: 33175237 PMCID: PMC7655500 DOI: 10.1007/s00737-020-01077-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/23/2020] [Indexed: 01/04/2023]
Abstract
The aims of this study were twofold: (1) to investigate the effectiveness of web-based psychoeducation for emotional functioning, eating behaviors, and body image among premenopausal women with excess body weight, and (2) to compare the efficacy of two types of web-based psychoeducation. Three hundred individuals were asked to volunteer in the present study. All participants were recruited in Poland from September 2017 to July 2019. Finally, a total of 129 premenopausal women took part in the research and signed informed consent. Their ages ranged between 18 and 48 years old (M = 32.28, SD = 7.65). Self-reported weight and height were recorded. BMI was calculated using self-reported data. Their average body mass index was 30.54 kg/m2 (SD = 3.69). In our randomized experiment, the participants were allocated into three groups: experimental group I (EG I, N = 43), experimental group II (EG II, N = 46), and wait list control group (CG, N = 40). Five questionnaires were included in the online survey at the baseline measurement (Day 0), at the end of psychoeducational intervention (Day 16) and 75 days from the start of the 15-day intervention (Day 76). Measurement tools included the Difficulties in Emotion Regulation Scale, the Positive and Negative Affect Schedule, the Mindful Eating Scale, the Three-Factor Eating Questionnaire, and the Body Attitude Test. Our eHealth web-based psychoeducation consisted of three modules: emotional functioning module (EG I: theoretically consistent approach (TCA) vs EG II: eclectic approach; EA), eating behaviors module (EG I, EG II: based on mindfulness-based eating training; MET), body image module (EG I, EG II: based on Cash's prevention of body image disturbances; CPBID). The first experimental group (EG I) had intervention containing TCA, MET, and CPBID, while the second experimental group (EG II) EA, MET, and CPBID. According to between-group comparison, both types of web-based psychoeducation led to an increase in adaptive emotion regulation (Day 16: EG I vs CG: p < 0.001, EG II vs CG: p < 0.001; Day 76: EG I vs CG: p < 0.01, EG II vs CG: p < 0.001). In EG I, the intervention resulted in a higher reduction (than in CG) in emotional eating (Day 16: p < 0.01, Day 76: p < 0.01), uncontrolled eating (Day 16: p < 0.05, Day 76: p < 0.05), and negative appreciation of body size (Day 16: p < 0.01, Day 76: p < 0.01). In EG II, a lower level of emotional eating was found on Day 76 (EG II vs CG: p < 0.05). Two months after completion of the 15-day intervention, no statistically significant reduction for BMI was observed in either experimental group (p > 0.05). The effectiveness of both types of web-based psychoeducation was also confirmed in within-group comparison (Day 0 vs Day 16 and Day 0 vs Day 76). There was a significant increase in emotion regulation and mindful eating, as well as a decrease in emotional eating, uncontrolled eating, negative appreciation of body size, lack of familiarity with one's body, and the experiencing of negative emotions in both experimental groups (EG I, EG II). Both types of web-based psychoeducation might have to be considered in creating future web-based psychoeducation among premenopausal women with excess body weight.
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18
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López-Hernández L, Martínez-Arnau FM, Pérez-Ros P, Drehmer E, Pablos A. Improved Nutritional Knowledge in the Obese Adult Population Modifies Eating Habits and Serum and Anthropometric Markers. Nutrients 2020; 12:E3355. [PMID: 33143306 PMCID: PMC7693073 DOI: 10.3390/nu12113355] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022] Open
Abstract
Multicomponent lifestyle interventions achieve good results in the management of obesity among the adult population. However, their implementation in certain populations poses difficulties. A good level of nutritional knowledge enables people to make changes in their diet that improve their health. This study aims to assess the relationship between nutritional knowledge and nutritional parameters such as dietary intake, anthropometric parameters and biomarkers. A before-after, non-randomized interventional study involving a two-monthly nutritional educational intervention was carried out over 8 months. Anthropometric and biomarker data were collected, and nutritional knowledge was evaluated using the Bach questionnaire and food frequency questionnaire (FFQ). The study comprised 66 overweight and obese adults with mean age of 50.23 years. Females predominated (84.8%). At the end of the intervention, nutritional knowledge increased significantly, with a significant reduction in the consumption of sweets, soft drinks, high-fat products, and processed meats, and an increase in the intake of lean meat and poultry. A 3% decrease in body weight was observed. An intervention for the management of obesity in the adult population based on nutritional education achieves weight loss, modifications in eating habits and reduction of fat intake. Increased nutritional knowledge is associated with healthier eating habits and a decreased cardiovascular risk.
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Affiliation(s)
- Lourdes López-Hernández
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, 46007 Valencia, Spain; (L.L.-H.); (F.M.M.-A.)
- Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Francisco Miguel Martínez-Arnau
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, 46007 Valencia, Spain; (L.L.-H.); (F.M.M.-A.)
- Department of Physiotherapy, Universitat de València, 46010 Valencia, Spain
- Frailty and Cognitive Impairment Research Group (FROG), Universitat de València, 46010 Valencia, Spain
| | - Pilar Pérez-Ros
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, 46007 Valencia, Spain; (L.L.-H.); (F.M.M.-A.)
- Frailty and Cognitive Impairment Research Group (FROG), Universitat de València, 46010 Valencia, Spain
- Department of Nursing, Faculty of Nursing and Podiatry, Universitat de València, 46010 Valencia, Spain
| | - Eraci Drehmer
- Department of Basic Sciences, Universidad Católica de Valencia San Vicente Mártir, 46007 Valencia, Spain;
| | - Ana Pablos
- Department of Physical Activity and Sport Sciences, Universidad Católica de Valencia San Vicente Mártir, 46007 Valencia, Spain;
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Developing evidence-based behavioural strategies to overcome physiological resistance to weight loss in the general population. Proc Nutr Soc 2020; 78:576-589. [PMID: 31670628 DOI: 10.1017/s0029665119001083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Physiological and behavioural systems are tolerant of excess energy intake and responsive to energy deficits. Weight loss (WL) changes body structure, physiological function and energy balance (EB) behaviours, which resist further WL and promote subsequent weight regain. Measuring and understanding the response of EB systems to energy deficits is important for developing evidence-based behaviour change interventions for longer-term weight management. Currently, behaviour change approaches for longer-term WL show modest effect sizes. Self-regulation of EB behaviours (e.g. goal setting, action plans, self-monitoring, relapse prevention plans) and aspects of motivation are important for WL maintenance. Stress management, emotion regulation and food hedonics may also be important for relapse prevention, but the evidence is less concrete. Although much is known about the effects of WL on physiological and psychological function, little is known about the way these dynamic changes affect human EB behaviours. Key areas of future importance include (i) improved methods for detailed tracking of energy expenditure, balance and by subtraction intake, using digital technologies, (ii) how WL impacts body structure, function and subsequent EB behaviours, (iii) how behaviour change approaches can overcome physiological resistance to WL and (iv) who is likely to maintain WL or relapse. Modelling physiological and psychological moderators and mediators of EB-related behaviours is central to understanding and improving longer-term weight and health outcomes in the general population.
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Diaz S, Hite A, Plunkett BA, Elue R, Victorson D. An exploration of the diagnosis and treatment of obesity among integrative medicine health care providers. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sun WYL, Switzer NJ, Dang JT, Gill R, Shi X, de Gara C, Birch D, Nataraj A, Karmali S. Idiopathic intracranial hypertension and bariatric surgery: a systematic review. Can J Surg 2020; 63:E123-E128. [PMID: 32195557 DOI: 10.1503/cjs.016616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Idiopathic intracranial hypertension (IIH) is a rare condition typically affecting women with obesity who are of child-bearing age. Patients commonly present with headaches, visual disturbances, pulsatile tinnitus and papilledema. The association between IIH and obesity has been well established in the literature, suggesting that weight loss may contribute to improving IIH. For patients with severe obesity for whom conservative management is not successful, bariatric surgery is an effective modality for weight loss. We aimed to systematically review the literature to determine the efficacy of bariatric surgery in the treatment of IIH Methods We conducted a comprehensive search of MEDLINE, Embase, Scopus, the Cochrane Library and Web of Science (limited to studies in humans published in English between January 1946 and July 2015). Results Twelve primary studies (n = 39 patients) were included in the systematic review. All patients had a preoperative diagnosis of IIH. Preoperative body mass index (BMI) was 47.4 ± 3.6 kg/m2 ; BMI improved to 33.7 ± 2.1 kg/m2 and 33.9 ± 11.6 kg/m2 at 6 and 12 months postoperatively, respectively. Lumbar puncture opening pressures decreased from 34.4 ± 6.9 cmH2O to 14.0 ± 3.6 cmH2O after surgery. Common symptoms of IIH improved after bariatric surgery: headaches (100% preoperatively v. 10% postoperatively), visual complaints (62% v. 44%), tinnitus (56% v. 3%) and papilledema (62% v. 8%). Conclusion Bariatric surgery appears to lead to considerable improvement in IIH. Idiopathic intracranial hypertension is not a well-publicized comorbidity of obesity, but its presence may be considered as an indication for bariatric surgery.
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Affiliation(s)
- Warren Y. L. Sun
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Noah J. Switzer
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Jerry T. Dang
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Richdeep Gill
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Xinzhe Shi
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Christopher de Gara
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Daniel Birch
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Andrew Nataraj
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
| | - Shahzeer Karmali
- From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj)
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Luig T, Wicklum S, Heatherington M, Vu A, Cameron E, Klein D, Sharma AM, Campbell-Scherer DL. Improving obesity management training in family medicine: multi-methods evaluation of the 5AsT-MD pilot course. BMC MEDICAL EDUCATION 2020; 20:5. [PMID: 31910854 PMCID: PMC6947955 DOI: 10.1186/s12909-019-1908-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Quality, evidence-based obesity management training for family medicine residents is needed to better support patients. To address this gap, we developed a comprehensive course based on the 5As of Obesity Management™ (ASK, ASSESS, ADVISE, AGREE, ASSIST), a framework and suite of resources to improve residents' knowledge and confidence in obesity counselling. This study assessed the course's impact on residents' attitudes, beliefs, and confidence with obesity counselling. METHODS The course combines lectures with a bariatric empathy suit experience, standardized and in-clinic patient practice, and narrative reflections. Using a multi-methods design we measured changes in 42 residents' attitudes, beliefs, and self-confidence and thematically analyzed the narrative reflections to understand residents' experience with the course content and pedagogy. RESULTS Following the course, residents reported improved attitudes towards people living with obesity and improved confidence for obesity counselling. Pre/post improvement in BAOP scores (n = 32) were significant (p < .001)., ATOP scores did not change significantly. Residents showed improvement in assessing root causes of weight gain (p < .01), advising patients on treatment options (p < .05), agreeing with patients on health outcomes (p < .05), assisting patients in addressing their barriers (p < .05), counseling patients on weight gain during pregnancy, (p < .05), counseling patients on depression and anxiety (p < .01), counseling patients on iatrogenic causes of weight gain (p < .01), counseling patients who have children with obesity (p < .05), and referring patients to interdisciplinary providers for care (p < .05). Qualitative analysis of narrative reflections illustrates that experiential learning was crucial in increasing residents' ability to empathically engage with patients and to critically reflect on implications for their practice. CONCLUSION The 5AsT-MD course has the potential to increase residents' confidence and competency in obesity prevention and management. Findings reflect the utility of the 5As to improve residents' confidence and competency in obesity management counselling.
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Affiliation(s)
- Thea Luig
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Canada
| | - Sonja Wicklum
- Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Melanie Heatherington
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Canada
| | - Albert Vu
- Core Internal Medicine, University of Alberta, Edmonton, Canada
| | - Erin Cameron
- Department of Human Sciences, Northern Ontario School of Medicine, Sudbury, Canada
| | - Doug Klein
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Arya M. Sharma
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, Canada
| | - Denise L. Campbell-Scherer
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, Edmonton, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, Canada
- 2-590 Edmonton Clinic Health Academy, Office of Lifelong Learning/Physician Learning Program, University of Alberta, Edmonton, AB T6G 1C9 Canada
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Xu M, Chattopadhyay K, Li J, Rai N, Chen Y, Hu F, Chu J, Li L. Weight Management Programme for Overweight and Obese Adults in Ningbo, China: A Feasibility Pre- and Post-intervention Study. Front Public Health 2019; 7:388. [PMID: 31921752 PMCID: PMC6930184 DOI: 10.3389/fpubh.2019.00388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 12/02/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the feasibility of conducting a randomized controlled trial (RCT) of a weight management programme in Ningbo, China. Methods: A pre- and post-intervention study was conducted in Ningbo. The study duration was from 01 July 2015 to 30 September 2017. Those aged 18-65 years of age, with a body mass index (BMI) of ≥24 kg/m2 (i.e., overweight/obese) and were willing to comply with the weight management programme were included in the study. The programme, focusing on lifestyle modification, was delivered by a multidisciplinary team over a period of 3-months. The study parameters were recruitment rate, follow-up rates at 3- and 6-month and standard deviation (SD) of the outcome measure (i.e., BMI). Results: Out of 261 people who gave written informed consent and were screened for eligibility, 193 (74%) were found eligible and were enrolled on to the programme. Those who enrolled on to the programme, 185 (96%) and 169 (88%) were followed up at 3- and 6-month, respectively. The SD of the outcome measure was 4.85. BMI reduced at 3-month follow-up (-1.98, 95% CI -2.19 to -1.79, p < 0.001) and at 6-month follow-up (-2.42, -2.71 to -2.11, <0.001). Conclusion: Based on the promising recruitment and follow-up rates in this study, it would be feasible to undertake the RCT of the weight management programme for overweight and obese adults in Ningbo. The SD of the outcome measure is used to calculate the sample size of the RCT. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: ChiCTR1900025861.
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Affiliation(s)
- Miao Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jialin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Nanin Rai
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Yanshu Chen
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Fangfang Hu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Jianping Chu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
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Manning K, Senekal M, Harbron J. Group-based intervention in a primary healthcare setting was more effective for weight loss than usual care. Health SA 2019; 24:1172. [PMID: 31934428 PMCID: PMC6917430 DOI: 10.4102/hsag.v24i0.1172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/10/2019] [Indexed: 02/05/2023] Open
Abstract
Background Literature and practice recommendations for lifestyle interventions to treat the increasing number of obese patients with non-communicable diseases (NCDs) or risk factors for NCDs attending resource-constrained public healthcare facilities in South Africa are scarce. Aim To compare the impact of a facility-based therapeutic group (FBTG) intervention with usual care on weight in obese participants, with NCDs or risk factors for NCDs. Setting Public healthcare facility providing primary healthcare services in Cape Town, South Africa. Methods A quasi-experimental study design was used where participants chose to receive weight loss treatment with either the FBTG or usual care interventions. Both interventions involved a one-on-one medical and dietetic consultation, while FBTG participants had six additional group sessions. Follow-up assessments took place 6 months after baseline. Socio-demographic variables, blood pressure, smoking status, weight, height, waist circumference, dietary intake, physical activity and stage of change were measured. Results Of the 193 obese adults enrolled, 96 selected the FBTG and 97 selected usual care. There were no significant differences at baseline between the two groups. Weight loss over 6 months was greater (p < 0.001) in FBTG (median [IQR] of −2.9 [−5.1; −0.3] kg) than usual care (−0.9 [−0.9; 0.6] kg) participants. At 6 months, more FBTG completers reached the weekly target of 150 min (p = 0.009), while both groups showed improvements in dietary intake. More FBTG (74%) than usual care (49%) participants were in the action stage of change by 6 months (p = 0.010). Conclusions The group-based intervention was more effective than usual care in weight reduction as well as improvements in physical activity and stage of change.
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Affiliation(s)
- Kathryn Manning
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Marjanne Senekal
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Janetta Harbron
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
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25
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Obesity prevention and the role of hospital and community-based health services: a scoping review. BMC Health Serv Res 2019; 19:453. [PMID: 31277640 PMCID: PMC6612151 DOI: 10.1186/s12913-019-4262-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022] Open
Abstract
Background Control of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research. Methods Databases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included papers evaluated interventions aimed at preventing overweight and obesity in adults that were implemented within and/or by hospital and community health services; were an empirical description of obesity prevention within a health setting or reported health staff perceptions of obesity and obesity prevention. Results The evidence supports screening for obesity of all healthcare patients, combined with referral to appropriate intervention services but indicates that health professionals do not typically adopt this practice. As well as practical issues such as time and resourcing, implementation is impacted by health professionals’ views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professional judgements about who might benefit from prevention and negative views about effectiveness of prevention hinder the implementation of practice guidelines. This is compounded by an often prevailing view that preventing obesity is a matter of personal responsibility and choice. Conclusions This review highlights that whilst a population health approach is important to address the complexity of obesity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention through screening and referral. Further research into the role of health services in obesity prevention should take a systems approach to examine how health service structures, policy and practice interrelationships, and service delivery boundaries, processes and perspectives impact on changing models of care.
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26
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Aboueid S, Meyer SB. Factors affecting access and use of preventive and weight management care: A public health lens. Healthc Manage Forum 2019; 32:136-142. [PMID: 30943766 DOI: 10.1177/0840470418824345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity is an important risk factor for various chronic diseases. While people with obesity use the health system more and incur higher costs, they may forego using preventive care services (e.g., gynecological cancer screenings) due to issues of service use and service access. The aim of this paper was to use a public health lens to elucidate system level factors that affect healthcare access and utilization for preventive and weight management care by patients with obesity. Some elucidated factors include lack of access to a Primary Care Provider (PCP) and multidisciplinary healthcare settings, gender of the PCP, duration of medical visits and health professionals' attitudes about obesity. We highlight potential strategies for leaders to use when improving access and use of health services by patients with obesity in Canada and the need for future empirical studies in this research area.
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Affiliation(s)
- Stephanie Aboueid
- 1 School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Samantha B Meyer
- 1 School of Public Health and Health Systems, Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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27
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Bouma AJ, van Wilgen P, Lemmink KAPM, Stewart R, Dijkstra A, Diercks RL. Barrier-belief lifestyle counseling in primary care: A randomized controlled trial of efficacy. PATIENT EDUCATION AND COUNSELING 2018; 101:2134-2144. [PMID: 30072044 DOI: 10.1016/j.pec.2018.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/14/2018] [Accepted: 07/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Intervening on barrier beliefs (BBs) may inhibit the role of barriers as mediating factors in lifestyle behavior. The aim of this study was to analyze the effects of a barrier-belief counseling intervention (BBCI) on physical activity (PA) and healthy food intake. METHODS An RCT was conducted in a primary care setting among adults (aged 18-70), with two interventions: a BBCI (n = 123) and a standardized lifestyle group intervention (SLI) (n = 122). A non-treated hanging control group (n = 36) received no intervention. Outcomes on PA (accelerometer and SQUASH) and fruit and vegetable intake (self-report) were measured with follow-ups at 6, 12 and 18 months, and analyzed using multiple regression. RESULTS The BBCI was more effective on PA compared with the SLI (p < .01): in the short term all PA outcomes improved (p < .05), in the long term moderate-to-vigorous PA outcomes improved (p < .05), all with small effect sizes. No differences between interventions were found on fruit and vegetable intake. None of the outcomes in the control group changed over time. CONCLUSIONS BBCI in primary care improves PA compared with SLI. PRACTICE IMPLICATIONS The customized BB approach seems promising for implementation in healthcare practice to stimulate PA.
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Affiliation(s)
- Adrie J Bouma
- Hanze University of Applied Sciences Groningen, Institute of Sports Studies, Zernikeplein 17, 9766 AS Groningen, The Netherlands.
| | - Paul van Wilgen
- Transcare, Transdisciplinary Pain Management Centre, Barkmolenstraat 196, 9723 DM Groningen, The Netherlands.
| | - Koen A P M Lemmink
- Center for Human Movement Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Roy Stewart
- Faculty of Medical Sciences, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
| | - Arie Dijkstra
- Faculty of Behavioral and Society Sciences, Grote Kruisstraat 2/1, 9712 TS, University of Groningen, Groningen, The Netherlands.
| | - Ron L Diercks
- Department of Sports Medicine and Orthopedic Surgery, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Vasquez K, Malhotra R, Østbye T, Low W, Chan MF, Chew L, Ling A. Lessons from Singapore's national weight management program, Lose To Win. Health Promot Int 2018; 33:834-845. [PMID: 28541435 DOI: 10.1093/heapro/dax021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The prevalence of overweight and obesity in Singapore is lower than in most countries, but it is increasing. There is evidence health complications may appear at lower weights among Asians. We describe the evolution of a national weight management program [Lose To Win (LTW)] organized by the Singapore Health Promotion Board from 2009 to 2013. LTW is a 12-week program comprising nutrition education, physical activity and mental wellbeing sessions and interim assessments. Individuals aged 18-69 years with a body mass index (BMI) between 23 and 37.4 kg/m2 were included. Primary outcomes were change in weight and BMI from baseline to end of 12-weeks. Effectiveness of the weight loss program was assessed using non-randomized control group (delayed intervention) during LTW 2010 and 2012. LTW 2009 enrolled 285 participants from 72 worksites. LTW 2010, expanded to the community, enrolling 952 participants (641 community-based and 311 workplace-based). In LTW 2012 and 2013, 959 and 1412 participants, respectively, were recruited from the community only. Completion rates of the 12-week program varied from 49 to 88%. Average weight loss ranged from 1.3 to 3.6 kg. For rounds including a control group, weight loss was higher in the intervention than in the control group. Competition and incentives were important motivators for participation. The LTW program was well-received and effective in producing short-term weight loss. Enhancements will be done to reinforce success factors in subsequent rounds to boost participation and follow-up rates and to ensure long-term sustainability.
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Affiliation(s)
- Kathryn Vasquez
- Obesity Prevention and Management, Health Promotion Board, Singapore
| | - Rahul Malhotra
- Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Truls Østbye
- Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, Singapore.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Wilson Low
- Research and Strategic Planning Division, Health Promotion Board, Singapore
| | - Mei Fen Chan
- Research and Strategic Planning Division, Health Promotion Board, Singapore
| | - Ling Chew
- Research and Strategic Planning Division, Health Promotion Board, Singapore
| | - Annie Ling
- Obesity Prevention and Management, Health Promotion Board, Singapore
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Groven KS, Dahl-Michelsen T. "I enjoy the treadmill very much": Moving beyond traditional understandings of self-efficacy in anti-obesity interventions. Physiother Theory Pract 2018; 36:469-475. [PMID: 29939805 DOI: 10.1080/09593985.2018.1488321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The last decade has seen increased focus on self-efficacy approaches in anti-obesity interventions. Self-efficacy approaches stemming from Bandura's social cognitive theory involve enhancing the patient's self-efficacy to ensure behavior change through exercise and dietary changes as well as weight-loss control. Inspired by Barad's theory of agential realism, this study explores self-efficacy by acknowledging that also non-human entities have agency. Drawing on one adolescent's experiences of testing herself while running on a treadmill, we put Barad's concept of "intra-acting" into play. Acknowledging the treadmill's agency as well as the agency of the program itself enables us to see the becoming nature of self-efficacy. As such, reading Bandura's concept of self-efficacy through Barad helps us discover more clearly the contingent and fluid process of self-efficacy, a process of becoming that needs to account for both human and non-human actors. Regarding how adolescents' anti-obesity programs can be designed and implemented to enhance self-efficacy, we argue that physiotherapists must understand the intra-active processes involved in such programs.
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Affiliation(s)
- Karen Synne Groven
- Department of Health, University of Oslo, Blindern, Oslo.,Oslo Metropolitan University, Institute of Physiotherapy, Olavsplass, Oslo, Norway
| | - Tone Dahl-Michelsen
- Oslo Metropolitan University, Institute of Physiotherapy, Olavsplass, Oslo, Norway
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Aboueid S, Bourgeault I, Giroux I. Nutrition care practices of primary care providers for weight management in multidisciplinary primary care settings in Ontario, Canada - a qualitative study. BMC FAMILY PRACTICE 2018; 19:69. [PMID: 29788914 PMCID: PMC5964672 DOI: 10.1186/s12875-018-0760-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
Abstract
Background Despite the recommended guidelines on addressing diet for the management and prevention of obesity in primary care, the literature highlights that their implementation has been suboptimal. In this paper, we provide an in-depth understanding of current nutrition-related weight management practices of primary care providers (PCPs) working in relatively new multidisciplinary health care settings in Ontario. Methods Three types of multidisciplinary primary care settings were included (2 Family Health Teams, 3 Community Health Centres and 1 Nurse Practitioner-Led Clinic). Participants (n = 20) included in this study were nurse practitioners (n = 13) and family physicians (n = 7) supporting care for adult patients (18 years or older). In-depth interviews were transcribed, coded and the content was analyzed using an integrated approach. Results Our analysis showed that most PCPs used anthropometric measures such as weight for screening patients who would benefit from nutrition counselling with a dietitian. The topic of nutrition was generally brought up either during physical examinations, when patients were diagnosed with a chronic disease, or when blood markers were out of normal range. Participants also mentioned that physical examinations are no longer occurring annually, with most PCPs offering episodic care. All participants reported utilizing dietetic referrals, noting the enablers for providing the referral, which included access to an on-site dietitian. Nonetheless, dietetic referrals were mostly used when patients had an obesity-related co-morbidity. Participants mentioned that healthy eating advice was reinforced during follow-up visits with patients only when there was enough time to do so. Electronic Health Records (EHRs) were utilized to facilitate message reinforcement by PCPs, who perceived EHRs to be helpful for viewing what was discussed in the session with the dietitian. Conclusions PCPs mostly used objective measures to screen for patients who would benefit from nutrition counselling rather than diet assessment, which undermines the importance of dietary intake and overemphasizes weight. With physical examinations occurring less frequently, there will be additional missed opportunities for addressing nutrition-related concerns. The presence of a dietitian on site allowed for PCPs to refer patients to nutrition counselling. Having sufficient time during medical visits and EHRs seemed to facilitate message reinforcement by PCPs in follow-up visits with patients. Electronic supplementary material The online version of this article (10.1186/s12875-018-0760-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie Aboueid
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Ivy Bourgeault
- Department of Health Systems, Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N6N5, Canada
| | - Isabelle Giroux
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N6N5, Canada
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Diet quality index as a predictor of treatment efficacy in overweight and obese adolescents: The EVASYON study. Clin Nutr 2018; 38:782-790. [PMID: 29730135 DOI: 10.1016/j.clnu.2018.02.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIM A diet quality index (DQI) is a tool that provides an overall score of an individual's dietary intake when assessing compliance with food-based dietary guidelines. A number of DQIs have emerged, albeit their associations with health-related outcomes are debated. The aim of the present study was to assess whether adherence to dietary intervention, and the overall quality of the diet, can predict body composition changes. METHODS To this purpose, overweight/obese adolescents (n = 117, aged: 13-16 years; 51 males, 66 females) were recruited into a multi-component (diet, physical activity and psychological support) family-based group treatment programme. We measured the adolescents' compliance and body composition at baseline and after 2 months (intensive phase) and 13 months (extensive phase) of follow-up. Also, at baseline, after 6 months, and at the end of follow-up we calculated the DQI. RESULTS Global compliance with the dietary intervention was 37.4% during the intensive phase, and 14.3% during the extensive phase. Physical activity compliance was 94.1% at 2-months and 34.7% at 13months and psychological support compliance were growing over the intervention period (10.3% intensive phase and 45.3% during extensive phase). Adolescents complying with the meal frequency criteria at the end of the extensive phase had greater reductions in FMI z-scores than those did not complying (Cohen's d = 0.53). A statistically significant association was observed with the diet quality index. DQI-A variation explained 98.1% of BMI z-score changes and 95.1% of FMI changes. CONCLUSIONS We conclude that assessment of changes in diet quality could be a useful tool in predicting body composition changes in obese adolescents involved in a diet and physical activity intervention programme backed-up by psychological and family support.
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New Possibilities in Life with Type 2 Diabetes: Experiences from Participating in a Guided Self-Determination Programme in General Practice. Nurs Res Pract 2018; 2018:6137628. [PMID: 29755787 PMCID: PMC5884023 DOI: 10.1155/2018/6137628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/04/2018] [Indexed: 01/18/2023] Open
Abstract
Research suggests that guided self-determination programmes can support self-management of diabetes by empowering self-determined goal setting and competence building. As most research in this area has focused on people with type 1 diabetes, knowledge is lacking on how adults with type 2 diabetes mellitus experience participation in such programmes. This study reports the modelling phase of a complex intervention design that explored the experiences of adults with type 2 diabetes who participated in a nurse-led guided self-determination programme in general practice and examines how the programme affected patients' motivation to self-manage diabetes. The qualitative design with semistructured interviews included 9 adults with type 2 diabetes who participated in the programme. Qualitative content analysis was used to analyse the data. The findings indicate that the participants experienced new life possibilities after participating in the programme, which seemed to have a positive influence on their motivation for self-management. Through reflections about how to live with diabetes, the participants reinterpreted their life with diabetes by gradually developing a closer relationship with the disease, moving towards acceptance. The fact that dialogue with the nurses was seen to be on an equal footing helped support the participants to become more self-determined.
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MacMillan F, George ES, Feng X, Merom D, Bennie A, Cook A, Sanders T, Dwyer G, Pang B, Guagliano JM, Kolt GS, Astell-Burt T. Do Natural Experiments of Changes in Neighborhood Built Environment Impact Physical Activity and Diet? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E217. [PMID: 29373567 PMCID: PMC5858286 DOI: 10.3390/ijerph15020217] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
Abstract
Physical activity and diet are major modifiable risk factors for chronic disease and have been shown to be associated with neighborhood built environment. Systematic review evidence from longitudinal studies on the impact of changing the built environment on physical activity and diet is currently lacking. A systematic review of natural experiments of neighborhood built environment was conducted. The aims of this systematic review were to summarize study characteristics, study quality, and impact of changes in neighborhood built environment on physical activity and diet outcomes among residents. Natural experiments of neighborhood built environment change, exploring longitudinal impacts on physical activity and/or diet in residents, were included. From five electronic databases, 2084 references were identified. A narrative synthesis was conducted, considering results in relation to study quality. Nineteen papers, reporting on 15 different exposures met inclusion criteria. Four studies included a comparison group and 11 were pre-post/longitudinal studies without a comparison group. Studies reported on the impact of redeveloping or introducing cycle and/or walking trails (n = 5), rail stops/lines (n = 4), supermarkets and farmers' markets (n = 4) and park and green space (n = 2). Eight/15 studies reported at least one beneficial change in physical activity, diet or another associated health outcome. Due to limitations in study design and reporting, as well as the wide array of outcome measures reported, drawing conclusions to inform policy was challenging. Future research should consider a consistent approach to measure the same outcomes (e.g., using measurement methods that collect comparable physical activity and diet outcome data), to allow for pooled analyses. Additionally, including comparison groups wherever possible and ensuring high quality reporting is essential.
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Affiliation(s)
- Freya MacMillan
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Emma S George
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia.
| | - Dafna Merom
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Andrew Bennie
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Amelia Cook
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Taren Sanders
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW 2060, Australia.
| | - Genevieve Dwyer
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Bonnie Pang
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Justin M Guagliano
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Gregory S Kolt
- School of Science and Health, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia.
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Jimenez MP, Green MA, Subramanian SV, Razak F. A demographic, clinical, and behavioral typology of obesity in the United States: an analysis of National Health and Nutrition Examination Survey 2011-2012. Ann Epidemiol 2018; 28:175-181.e4. [PMID: 29402536 DOI: 10.1016/j.annepidem.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Public health reporting, randomized trials, and epidemiologic studies of obesity tend to consider it as a homogeneous entity. However, obesity may represent a heterogeneous condition according to demographic, clinical, and behavioral factors. We assessed the heterogeneity of individuals with obesity in the United States. METHODS We analyzed data from the 2011-2012 wave of the National Health and Nutrition Examination Survey, a nationally representative sample of adults in the United States with detailed physical examination and clinical data (n = 1380). We used cluster analysis to identify subgroups classified as obese according to demographic factors, clinical conditions, and behavioral characteristics. RESULTS We found significant heterogeneity among participants with obesity according to six distinct clusters (P < .001): affluent men with sleep disorders (16% of sample); older smokers with cardiovascular disease (16%); older women with high comorbidity (20%); healthy white women (13%); healthy non-white women (14%); and active men who drink higher amounts of alcohol (21%). CONCLUSIONS Obesity in the United States is not a homogeneous condition. Current research and treatment may fail to account for complex and interrelated factors, with implications for prevention strategies and diverse risks of obesity.
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Affiliation(s)
- Marcia P Jimenez
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI
| | - Mark A Green
- Department of Geography & Planning, University of Liverpool, Liverpool, UK
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA; Harvard Centre for Population and Development Studies, Harvard University, Cambridge, MA
| | - Fahad Razak
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada; St Michael's Hospital, University of Toronto and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Harvard Centre for Population and Development Studies, Harvard University, Cambridge, MA.
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Doherty AJ, Jones SP, Chauhan U, Gibson JME. An integrative review of multicomponent weight management interventions for adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31 Suppl 1:39-51. [PMID: 28631874 PMCID: PMC5811836 DOI: 10.1111/jar.12367] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity is more prevalent in people with intellectual disabilities and increases the risk of developing serious medical conditions. UK guidance recommends multicomponent weight management interventions (MCIs), tailored for different population groups. METHODS An integrative review utilizing systematic review methodology was conducted to identify the types of MCIs delivered to adults with intellectual disabilities. FINDINGS Five studies were identified. All of the studies' MCIs were tailored for adults with intellectual disabilities. Tailoring included measures such as simplified communication tools, individualized sessions, and the presence of carers where appropriate. CONCLUSIONS Emerging evidence suggests ways in which MCIs can be tailored for adults with intellectual disabilities but, given the few studies identified, it is not possible to recommend how they can be routinely tailored. Further studies are justified for adults with intellectual disabilities at risk of obesity-related conditions.
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Affiliation(s)
- Alison J. Doherty
- National Institute for Health Research (NIHR)Collaboration for Leadership in Applied Health Research and Care, North West Coast (CLAHRC, NWC)PrestonUK
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
| | - Stephanie P. Jones
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
| | - Umesh Chauhan
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
- MacKenzie Chair in Primary Care MedicineUniversity of Central Lancashire; GP and CVD LeadEast Lancashire Clinical Commissioning GroupUK
| | - Josephine M. E. Gibson
- National Institute for Health Research (NIHR)Collaboration for Leadership in Applied Health Research and Care, North West Coast (CLAHRC, NWC)PrestonUK
- School of NursingFaculty of Health & WellbeingUniversity of Central LancashirePrestonUK
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36
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Winik CL, Bonham CE. Implementation of a Screening and Management of Overweight and Obesity Clinical Practice Guideline in an Ambulatory Care Setting. Mil Med 2018; 183:e32-e39. [PMID: 29401347 DOI: 10.1093/milmed/usx022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction Obesity is a rapidly growing health problem reaching epidemic levels around the world (World Health Organization, 2014). According to the World Health Organization, the current incident rate of obesity makes it the leading risk for deaths across the globe. The United States (USA) is amidst in this growing global epidemic. The obesity epidemic is a nondiscriminatory health problem affecting millions of individuals from a variety of backgrounds and social status. One group impacted by this disease is the US military. The health-related consequences of overweight and obesity has increased our military health care expenditures and has a direct impact on our nation's military readiness (Veterans Affairs/Department of Defense, 2014). Materials and Methods The purpose of this Doctor of Nursing Practice project was to implement the Veterans Affairs/Department of Defense's Clinical Practice Guideline on Screening and Management of Overweight and Obesity at a military treatment facility in the Midwest. The goal of the project was to reduce the incidence rate of overweight and obese active duty military service members assigned to a military installation in the Midwest. With institutional review board approval, project implementation results were analyzed with descriptive and inferential statistics (paired t- tests). Results The goal to reduce the incident rate of overweight and obese by 5% was not achieved, but in turn the rate of overweight and obese increased by 1.57% over the 6-mo period. There were decreases in the normal with an increase in the overweight and obesity rate. This inverse outcome was unexpected and concerning. Conclusion Based on the project's finding, there is a need to address the perceived barriers to maintaining healthy behaviors to plan future activities. An in-depth look at whether there is a knowledge deficit, a perceived lack of self-efficacy, competing life priorities preventing engagement in health promotion behaviors, or some other element influencing the motivation to change would be beneficial to understanding how to curb the growing rate of obesity. The utilization of the transtheoretical model of behavior change would make a sound theoretical framework to base such a new study, focusing on the stages of change as it relates to health promotion behaviors.
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Affiliation(s)
- Connie L Winik
- 55th Medical Group, Ehrling Bergquist Clinic, United States Air Force, 2501 Capehart Road, Offutt Air Force Base, NE 68113
| | - C Elizabeth Bonham
- College of Nursing and Health Professions, University of Southern Indiana, 8600 University Boulevard, Evansville IN 47712
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Blackford K, Lee A, James AP, Waddell T, Hills AP, Anderson AS, Howat P, Jancey J. Process evaluation of the Albany Physical Activity and Nutrition (APAN) program, a home-based intervention for metabolic syndrome and associated chronic disease risk in rural Australian adults. Health Promot J Austr 2017; 28:8-14. [PMID: 27426475 DOI: 10.1071/he16027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/09/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed The Albany Physical Activity and Nutrition (APAN) study investigated the effects of the APAN program, a home-based intervention on dietary and physical activity behaviours and chronic disease risk for rural Australian adults. This paper reports on the process evaluation to gain insight into the link between intervention elements and outcomes. Methods The APAN program comprised resources to improve participants' diet and physical activity. Printed and online resources were provided to participants, complemented by motivational interviews via telephone. Process evaluation used mixed-methods, with a sample of 201 intervention participants residing in a disadvantaged rural area. Participants were aged 50 to 69 years with, or at risk of, metabolic syndrome. Quantitative data were collected using an online survey (n=73); qualitative data were collected via telephone exit interviews with intervention completers (n=8) and non-completers (n=8), and recruitment notes recorded by research assistants. Results The attrition rate of the program was 18%; major reasons for withdrawal were health and personal issues and a loss of interest. The majority of participants found the printed resources useful, attractive, and suitable to their age group. The website was the least preferred resource. Reasons for completing the program included the desired health benefits, wanting to honour the commitment, and wanting to assist with research. Conclusions Carefully planned recruitment will reduce the burden on resources and improve uptake. Understanding reasons for attrition such as family or personal barriers and health issues will assist practitioners to support participants overcome these barriers. Given participants' preference for printed resources, and the known effectiveness of these in combination with other strategies, investigating methods to encourage use of telephone and online support should be a priority. So what? This process evaluation provided an overview of recruitment challenges and preferred intervention components. It is desirable that future work determines the most effective intervention components for rural adults at risk of chronic disease.
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Affiliation(s)
- Krysten Blackford
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Andy Lee
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Anthony P James
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Tracy Waddell
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Andrew P Hills
- School of Health Sciences, University of Tasmania, Locked Bag 1322, Newnham Drive, Launceston, Tas. 7250, Australia
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, Division of Cancer Research, Level 7, Mailbox 7, Ninewells Medical School, Dundee DD1 9SY, Scotland
| | - Peter Howat
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, GPO Box U1987, Perth, WA 6845, Australia
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Ramos Salas X, Alberga AS, Cameron E, Estey L, Forhan M, Kirk SFL, Russell-Mayhew S, Sharma AM. Addressing weight bias and discrimination: moving beyond raising awareness to creating change. Obes Rev 2017; 18:1323-1335. [PMID: 28994243 DOI: 10.1111/obr.12592] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/18/2017] [Accepted: 06/26/2017] [Indexed: 01/05/2023]
Abstract
Weight discrimination is the unjust treatment of individuals because of their weight. There have been very few interventions to address weight discrimination, due in part to the lack of consensus on key messages and strategies. The objective of the third Canadian Weight Bias Summit was to review current evidence and move towards consensus on key weight bias and obesity discrimination reduction messages and strategies. Using a modified brokered dialogue approach, participants, including researchers, health professionals, policy makers and people living with obesity, reviewed the evidence and moved towards consensus on key messages and strategies for future interventions. Participants agreed to these key messages: (1) Weight bias and obesity discrimination should not be tolerated in education, health care and public policy sectors; (2) obesity should be recognized and treated as a chronic disease in health care and policy sectors; and (3) in the education sector, weight and health need to be decoupled. Consensus on future strategies included (1) creating resources to support policy makers, (2) using personal narratives from people living with obesity to engage audiences and communicate anti-discrimination messages and (3) developing a better clinical definition for obesity. Messages and strategies should be implemented and evaluated using consistent theoretical frameworks and methodologies.
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Affiliation(s)
- X Ramos Salas
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Canadian Obesity Network, Edmonton, Alberta, Canada
| | - A S Alberga
- University of Calgary, Calgary, Alberta, Canada.,Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - E Cameron
- School of Human Kinetics and Recreation, Memorial University, St. John's, Newfoundland, Canada
| | - L Estey
- Canadian Obesity Network, Edmonton, Alberta, Canada
| | - M Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - S F L Kirk
- Dalhousie University, IWK Health Centre and Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - S Russell-Mayhew
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | - A M Sharma
- Canadian Obesity Network, Edmonton, Alberta, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Cochrane AJ, Dick B, King NA, Hills AP, Kavanagh DJ. Developing dimensions for a multicomponent multidisciplinary approach to obesity management: a qualitative study. BMC Public Health 2017; 17:814. [PMID: 29037238 PMCID: PMC5644160 DOI: 10.1186/s12889-017-4834-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 10/06/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There have been consistent recommendations for multicomponent and multidisciplinary approaches for obesity management. However, there is no clear agreement on the components, disciplines or processes to be considered within such an approach. In this study, we explored multicomponent and multidisciplinary approaches through an examination of knowledge, skills, beliefs, and recommendations of stakeholders involved in obesity management. These stakeholders included researchers, practitioners, educators, and patients. METHODS We used qualitative action research methods, including convergent interviewing and observation, to assist the process of inquiry. RESULTS The consensus was that a multicomponent and multidisciplinary approach should be based on four central meta-components (patient, practitioner, process, and environmental factors), and specific components of these factors were identified. Psychologists, dieticians, exercise physiologists and general practitioners were nominated as key practitioners to be included. CONCLUSIONS A complex condition like obesity requires that multiple components be addressed, and that both patients and multiple disciplines are involved in developing solutions. Implementing cycles of continuous improvement to deal with complexity, instead of trying to control for it, offers an effective way to deal with complex, changing multisystem problems like obesity.
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Affiliation(s)
- Anita J. Cochrane
- Institute of Health and Biomedical Innovation, School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001 Australia
- LifePsyche, Box 3180, Norman Park, Brisbane, PO 4170 Australia
| | - Bob Dick
- Interchange, 37 Burbong Street, Chapel Hill, Brisbane, QLD 4069 Australia
| | - Neil A. King
- Institute of Health and Biomedical Innovation, Faculty of Health, Queensland University of Technology, GPO Box 2434, Brisbane, QLD 4001 Australia
| | - Andrew P. Hills
- School of Health Sciences, Faculty of Health, University of Tasmania, Locked Bag 1322, Newnham Drive, Launceston, TAS 7250 Australia
| | - David J. Kavanagh
- Institute of Health and Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, GPO Box 2434, Brisbane, 4001 Australia
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40
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Salas XR, Forhan M, Caulfield T, Sharma AM, Raine K. Authors' response to Invited Commentary by Brady and Beausoleil. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2017; 108:e646-e647. [PMID: 31823278 PMCID: PMC6972087 DOI: 10.17269/cjph.108.6559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Elahmedi MO, Alqahtani AR. Evidence Base for Multidisciplinary Care of Pediatric/Adolescent Bariatric Surgery Patients. Curr Obes Rep 2017; 6:266-277. [PMID: 28755177 DOI: 10.1007/s13679-017-0278-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Severe childhood obesity, defined as having a body mass index (BMI) greater than the 99th percentile for age and gender, is rising in most countries and is associated with early morbidity and mortality. Optimal management of the health of the child with obesity requires a multidisciplinary approach that identifies and treats associated derangements. RECENT FINDINGS Lifestyle interventions such as diet, exercise, and behavioral therapy for the severely obese pediatric patient are generally not effective. Few centers worldwide offer bariatric surgery for adolescents in a multidisciplinary setting, and we are the only center that offers a multidisciplinary approach that incorporates bariatric surgery for severely obese children and adolescents across all age groups. In this paper, we review up-to-date evidence in this subject including ours, and provide details on the multidisciplinary approach to pediatric obesity that accommodates bariatric surgery for children across all age groups.
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Affiliation(s)
- Mohamed O Elahmedi
- Department of Surgery, College of Medicine, King Saud University, 1 Baabda, Riyadh, 11472, Saudi Arabia
| | - Aayed R Alqahtani
- Department of Surgery, College of Medicine, King Saud University, 1 Baabda, Riyadh, 11472, Saudi Arabia.
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Salas XR, Forhan M, Caulfield T, Sharma AM, Raine K. A critical analysis of obesity prevention policies and strategies. Canadian Journal of Public Health 2017; 108:e598-e608. [PMID: 31823280 DOI: 10.17269/cjph.108.6044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/25/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Public health policies have been criticized for promoting a simplistic narrative that may contribute to weight bias. Weight bias can impact population health by increasing morbidity and mortality. The objectives of this study were to: 1 ) critically analyze Canadian obesity prevention policies and strategies to identify underlying dominant narratives; 2) deconstruct dominant narratives and consider the unintended consequences for people with obesity; and 3) make recommendations to change dominant obesity narratives that may be contributing to weight bias. METHODS We applied Bacchi's "what's-the-problem-represented-to-be?" (WPR) approach to 15 obesity prevention policies and strategies (1 national, 2 territorial and 12 provincial). Bacchi's WPR approach is composed of six analytical questions designed to identify conceptual assumptions as well as possible effects of policies. RESULTS We identified five prevailing narratives that may have implications for public health approaches and unintended consequences for people with obesity: 1 ) childhood obesity threatens the health of future generations and must be prevented; 2) obesity can be prevented through healthy eating and physical activity; 3) obesity is an individual behaviour problem; 4) achieving a healthy body weight should be a population health target; and 5) obesity is a risk factor for other chronic diseases, not a disease in itself. CONCLUSION The consistent way in which obesity is constructed in Canadian policies and strategies may be contributing to weight bias in our society. We provide some recommendations for changing these narratives to prevent further weight bias and obesity stigma.
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Affiliation(s)
- Ximena Ramos Salas
- Centre for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Arya M Sharma
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kim Raine
- Centre for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, AB, Canada
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Abstract
AIM There is a need to develop sound healthcare practices where patients and providers are able to succeed in meeting weight management goals. The aim of this analysis is to develop a better understanding the concept of weight management. BACKGROUND Obesity is a rapidly growing healthcare issue, reaching epidemic levels around the world. According to the World Health Organization, the current incident rate of obesity makes it the leading risk for death across the globe. DESIGN Walker and Avant's model for concept analysis. DATA SOURCE A literature search was accomplished using Cumulative Index to Nursing and Allied Health, Health Source: Nursing Academic Edition, Medline, and ProQuest Health and Medical Complete. REVIEW METHODS Keywords included weight management, weight control, weight loss, obesity, weight, and management. RESULTS Weight management is complex concept. Strategies to develop successful weight management programs need to be multifaceted to have impact on this healthcare crisis. CONCLUSION The critical attributes for weight management are dietary measures, physical activity, behavior modification, motivation, education, and lifelong changes. Unsuccessful weight management results in metabolic disorders and increased risk of mortality. Successful weight management practices include the prevention of weight gain, weight loss, and maintenance of ideal body weight.
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Affiliation(s)
- Connie L Winik
- Student, College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN
| | - C Elizabeth Bonham
- Student, College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN
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Hoedjes M, van Stralen MM, Joe STA, Rookus M, van Leeuwen F, Michie S, Seidell JC, Kampman E. Toward the optimal strategy for sustained weight loss in overweight cancer survivors: a systematic review of the literature. J Cancer Surviv 2017; 11:360-385. [PMID: 28097452 PMCID: PMC5418328 DOI: 10.1007/s11764-016-0594-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/20/2016] [Indexed: 12/05/2022]
Abstract
PURPOSE To gain more insight into the optimal strategy to achieve weight loss and weight loss maintenance in overweight and obese cancer survivors after completion of initial treatment, this systematic review aimed to provide an overview of the literature on intervention effects on weight, to describe intervention components used in effective interventions, to identify and synthesize behaviour change techniques (BCTs) and to assess the frequency with which these BCTs were used in effective interventions. METHODS Six databases were searched for original research articles describing weight changes in adult overweight cancer survivors after participation in a lifestyle intervention initiated after completion of initial treatment. Two researchers independently screened the retrieved papers and extracted BCTs using the BCT Taxonomy version 1. RESULTS Thirty-two papers describing 27 interventions were included. Interventions that were evaluated with a robust study design (n = 8) generally showed <5% weight loss and did not evaluate effects at ≥12 months after intervention completion. Effective interventions promoted both diet and physical activity and used the BCTs 'goal setting (behaviour)', 'action planning', 'social support (unspecified)' and 'instruction on how to perform the behaviour'. CONCLUSIONS The results of this first review on intervention components of effective interventions could be used to inform intervention development and showed a need for future publications to report long-term effects, a detailed intervention description and an extensive process evaluation. IMPLICATIONS FOR CANCER SURVIVORS This study contributed to increasing knowledge on the optimal strategy to achieve weight loss, which is recommended for overweight cancer survivors to improve health outcomes.
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Affiliation(s)
- Meeke Hoedjes
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Maartje M van Stralen
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Sheena Tjon A Joe
- Department of Dietetics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Matti Rookus
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Flora van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, UCL Centre for Behaviour Change, University College London, London, UK
| | - Jacob C Seidell
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Ellen Kampman
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Héroux M, Watt M, McGuire K, Berardi J. A personalized, multi-platform nutrition, exercise, and lifestyle coaching program: A pilot in women. Internet Interv 2017; 7:16-22. [PMID: 30135822 PMCID: PMC6096260 DOI: 10.1016/j.invent.2016.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 11/07/2016] [Accepted: 12/20/2016] [Indexed: 01/22/2023] Open
Abstract
The aim of this pilot study was to examine if a personalized web-based multi-platform nutrition, exercise, and lifestyle coaching program, supported weight loss and the reduction of chronic disease risk factors in overweight or obese women. Twenty-eight women completed the program, which represented 50% of those who provided baseline data. The program consisted of a one-year curriculum with daily exercise, nutritional habits, and health behaviour lessons along with access to a one-on-one coach. The workouts, habits, and lessons were available via computer, tablet, and mobile device which, along with coaching, facilitated self-monitoring and accountability. At baseline and 12-months, weight, waist circumference, fat mass, muscle mass, blood pressure, total cholesterol, low density lipoproteins, high density lipoproteins, triglycerides, C reactive protein, and fasting glucose were collected. Over the 12 months, women who completed the program, (average age 49.64 (SD 10.99) years), lost 16.52 (SD 13.63) lbs (P < 0.001), and reduced waist circumference by 3.56 (SD 2.31) in (P < 0.0001). Diastolic blood pressure decreased by 3.77 (SD 7.25) mm Hg (P = 0.02) and high density lipoproteins increased by 0.16 (SD 0.28) mmol/L (P = 0.01). No other risk factors changed significantly. Compliance was a significant predictor of weight loss (P < 0.01). In conclusion, women who completed the web-based program experienced significant weight loss (8.62% of initial body weight) coming predominantly from body fat. Chronic disease risk factors also improved.
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Affiliation(s)
- M. Héroux
- Precision Nutrition, Toronto, Ontario, Canada
| | - M. Watt
- Festubert Family Practice, Duncan, British Columbia, Canada
| | - K.A. McGuire
- Alberta Health Services, Calgary, Alberta, Canada
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Torti J, Luig T, Borowitz M, Johnson JA, Sharma AM, Campbell-Scherer DL. The 5As team patient study: patient perspectives on the role of primary care in obesity management. BMC FAMILY PRACTICE 2017; 18:19. [PMID: 28178930 PMCID: PMC5299769 DOI: 10.1186/s12875-017-0596-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/26/2017] [Indexed: 12/04/2022]
Abstract
Background Over 60% of people have overweight or obesity, but only a third report receiving counselling from primary care providers. We explored patients’ perspectives on the role of primary care in obesity management and their experience with existing resources, with a view to develop an improved understanding of this perspective, and more effective management strategies. Methods Qualitative study employing semi-structured interviews and thematic analysis, with a sample of 28 patients from a cohort of 255 patients living with obesity and receiving care to support their weight management in a large Primary Care Network of family practices in Alberta. Results Four illustrative themes emerged: (1) the patient-physician relationship plays an important role in the adequacy of obesity management; (2) patients have clear expectations of substantive conversations with their primary care team; (3) complex conditions affect weight and patients require assistance tailored to individual obesity drivers; (4) current services provide support in important ways (accessibility, availability, accountability, affordability, consistency of messaging), but are not yet meeting patient needs for individual plans, advanced education, and follow-up opportunities. Conclusions Patients have clear expectations that their primary care physician asks them about weight within a supportive therapeutic relationship. They see obesity as a complex phenomenon with multiple drivers. They want their healthcare providers to assess and address their root causes - not simplistic advice to “eat less, move more”. Patients felt that the current services were positive resources, but expressed needs for tailored weight management plans, and longer-term follow-up.
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Affiliation(s)
- Jacqueline Torti
- Department of Family Medicine, University of Alberta, Clinical Research Unit, Edmonton, AB, Canada, T6G 2E1.,School of Public Health, University of Alberta, Edmonton, AB, Canada, T6G 2E3
| | - Thea Luig
- Department of Family Medicine, University of Alberta, Clinical Research Unit, Edmonton, AB, Canada, T6G 2E1.,Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada, T6G 2E1
| | - Michelle Borowitz
- Department of Anthropology, University of Alberta, Edmonton, AB, Canada, T6G 2H4
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, AB, Canada, T6G 2E3
| | - Arya M Sharma
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada, T6G 2E1
| | - Denise L Campbell-Scherer
- Department of Family Medicine, University of Alberta, Clinical Research Unit, Edmonton, AB, Canada, T6G 2E1. .,Department of Medicine, Obesity Research & Management, University of Alberta, Li Ka Shing Building, Rm. 1-116, 87th Avenue and 112th Street, Edmonton, AB, T6G 2E1, Canada.
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Annesi JJ, Mareno N. Psychosocial changes as correlates of weight regain vs. continued loss within 2-year trials of a self-regulation-focused community-based intervention. Clin Obes 2017; 7:22-33. [PMID: 28079977 DOI: 10.1111/cob.12173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/07/2016] [Accepted: 11/29/2016] [Indexed: 11/29/2022]
Abstract
Although health-enhancing weight reductions are associated with behavioural treatments initially, a trajectory towards full regain typically begins within 6-9 months. Women with obesity (body mass index = 30-40 kg m-2 ) who lost at least 3% of their baseline weight within two trials of a new cognitive-behavioural treatment incorporating physical activity prior to changes in eating behaviours, and either regained ≥50% of that weight over 2 years (Regain group, n=32) or continued to lose weight (ContinuedLoss group, n = 34), were assessed from months 6 to 24 on changes in weight-loss behaviours and psychosocial predictors of those behaviours derived from established behavioural theories. For the Regain group, significant decreases in physical activity and fruit/vegetable intake during months 12-24, from both months 6 to 24 and 12 to 24 in eating- and physical activity-related self-regulation and from months 6 to 24 in eating-related self-efficacy (i.e. feelings of ability), were found. No significant behavioural or psychosocial changes were found over those times in the ContinuedLoss group. Changes in self-regulation and self-efficacy completely mediated the relationship between changes in fruit/vegetable intake and group (Regain vs. ContinuedLoss) (McFadden's R 2 = 0.19 and 0.20, respectively), with self-regulation independently contributing to the explained variance. Changes over both months 6-24 and 12-24 in self-regulation significantly mediated the relationship between changes in physical activity and group membership (McFadden's R 2 = 0.24 and 0.27, respectively). Findings suggested that approximately 6 months after treatment initiation would be a suitable time to intervene with some bolstering methods, while approximately 12 months post-initiation would be most applicable for others.
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Affiliation(s)
- J J Annesi
- Wellness Department, YMCA of Metro Atlanta, Atlanta, GA, USA
- Department of Health Promotion and Physical Education, Kennesaw State University, Kennesaw, GA, USA
| | - N Mareno
- Wellstar School of Nursing, Kennesaw State University, Kennesaw, GA, USA
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Nossum R, Johansen AE, Kjeken I. Occupational problems and barriers reported by individuals with obesity. Scand J Occup Ther 2017; 25:136-144. [PMID: 28103728 DOI: 10.1080/11038128.2017.1279211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Even if occupational therapists meet many people with obesity in the course of their work, a majority of them do not seem to view weight management as within their area of professional practice. AIM To explore the occupational problems and barriers among persons with severe obesity from an occupational therapy perspective. MATERIALS AND METHODS The study used the Canadian Model of Occupation and Engagement (CMOP-E) and Canadian Occupational Performance Measure (COPM) to identify and analyze prioritized occupational performance problems and barriers perceived by 63 individuals with obesity. RESULTS The occupational problems individuals with obesity most frequently prioritized comprised playing with (grand)children, purchasing clothes, implementing regular meals and going to the swimming pool, while the barriers they most frequently described were dyspnea, musculoskeletal disorders, narrow chairs and seats, fear of glances and comments from others, and social anxiety. CONCLUSION Persons with obesity struggle with a large variety of occupational performance problems, which occur in the dynamic relationship between these individuals, their environment and their occupation. Occupational therapists have the skills to take more active role in helping persons with obesity to perform valued occupations and establish healthier everyday routines.
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Affiliation(s)
- Randi Nossum
- a Department of Clinical Services , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
| | - Ann-Elin Johansen
- a Department of Clinical Services , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway
| | - Ingvild Kjeken
- b Diakonhjemmet Hospital, National Advisory Unit on Rehabilitation in Rheumatology , Oslo , Norway.,c Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
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Blais LT, Mack DE, Wilson PM, Blanchard CM. Challenging body weight: evidence from a community-based intervention on weight, behaviour and motivation. PSYCHOL HEALTH MED 2016; 22:872-878. [PMID: 27998180 DOI: 10.1080/13548506.2016.1271440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this study was to examine the effectiveness of a 12 week weight loss intervention within a commercial fitness centre on body weight, moderate to vigorous physical activity (MVPA), dietary intake, and behavioural regulations for exercise and healthy eating. Using a quasi-experimental design, the intervention group received weekly coaching sessions and bi-weekly seminars designed to increase MVPA and improve dietary intake. Outcome variables were assessed at three time points over a six month period. Results showed a significant interaction for body weight (p = .04) and dietary changes (p < .05) following the weight loss challenge but were not maintained across the six month period. Changes in behavioural regulations favoured the intervention condition. Results imply that a 12 week weight loss challenge within a commercial fitness centre may be effective at prompting short-term weight loss and support the internalization of behavioural regulations specific to healthy eating and exercise.
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Affiliation(s)
- Louise T Blais
- a Department of Human Kinetics , Okanagan College , Kelowna , Canada
| | - Diane E Mack
- b Behavioural Health Sciences Research Lab, Faculty of Applied Health Sciences, Department of Kinesiology , Brock University , St. Catharines , Canada
| | - Philip M Wilson
- b Behavioural Health Sciences Research Lab, Faculty of Applied Health Sciences, Department of Kinesiology , Brock University , St. Catharines , Canada
| | - Chris M Blanchard
- c Department of Medicine, Centre for Clinical Research, QEII Health Sciences Centre , Dalhousie University , Halifax , Canada
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