Establishing the stages and processes of change for weight loss by consensus of experts

Mental and Physical Readiness for Weight Loss After Abdominal Organ Transplant

INTRODUCTION

Readiness to incorporate healthy lifestyle practices is not studied in posttransplant patients. We evaluate physical and mental readiness for a weight-loss guided lifestyle intervention.

METHODS

12 kidney and 12 liver transplant patients were given a Fitbit and weighing scale for 12 mo. Twelve patients received group sessions on lifestyle modifications. Mental readiness was assessed using Patient Activation Measurement-13, Physical Activity, Process of Change, and Weight Stages of Change. Physical readiness was assessed using Fatigue, Resistance, Ambulation, Illness, and Loss of Weight, and Short Physical Performance Battery questionnaires. Weight change, group session attendance, device usage, and readiness were analyzed.

RESULTS

23 patients (12 kidney, 11 liver), 57 y (46.2-67.5), 75% male, 24.9 (15.7-43.2) months posttransplant) completed the study. Twenty-two patients had robust physical readiness, and high Fitbit usage (>80%). Ten patients (43%) lost ≥2.5% (moderate) of body weight, including 4 (17.3%) losing >5% total weight (high). 13 patients lost ≤2.5% or gained weight (maintenance). High loss and target group session attendance groups had the highest use of Processes of Change.

CONCLUSIONS

Posttransplant patients are physically ready for a weight-loss guided lifestyle intervention and show high usage of the Fitbit device. Higher mental readiness associates with higher weight loss.

Psychometric Properties of the Weight Loss Readiness Test in Active Duty Military Personnel Enrolled in a Weight Management Trial

INTRODUCTION

The Weight Loss Readiness Test (WLRT) was developed to encourage consideration of factors influencing readiness to engage in weight loss. The WLRT is used clinically, most notably to assess motivation before initiating Navy weight management programs, yet little is known about its psychometric properties.

MATERIALS AND METHODS

This study examined the reliability, convergent and predictive validity, and factor structure of the WLRT in a sample of active duty service members enrolling in a Navy-based weight management program (N = 178, identified as female = 61%, mean age = 29.7 years, mean baseline body mass index = 33.1 kg/m2). All procedures were approved by the respective Institutional Review Boards and research committees.

RESULTS

Exploratory factor analysis revealed a 5-factor structure explaining 52% of the variance that best fit the data with low to moderate correlations between factors: (1) Motivation, (2) Exercise-Related Confidence, (3) Non-Exercise Confidence, (4) Cues, and (5) Anticipated Satisfaction. Internal reliability of subscales was acceptable to good (α = 0.755-0.903). Generally, convergent validity was found between the identified subscales and other measures of motivation, confidence, and disinhibited eating in expected directions. No relationships were found between the subscales and predictive validity outcomes (weight change, program attendance).

CONCLUSIONS

Results indicate adequate structural and convergent validity in the WLRT, but that weight loss readiness, as measured by the WLRT, does not provide predictive validity regarding weight loss or attendance outcomes in this sample. Nonetheless, this measure offers clinical utility in fostering thoughtful conversations about weight loss. The WLRT uniquely focuses on long-term maintenance of behavior change and differentiates between exercise-related and non-exercise confidence. Future studies should further probe the utility of this measure in other populations and the contexts in which it is being used.

Web-Based Intervention to Act for Weight Loss in Adults With Type 2 Diabetes With Obesity (Chance2Act): Protocol for a Nonrandomized Controlled Trial

BACKGROUND

In adults with type 2 diabetes (T2D), weight loss can improve hemoglobin A1c, blood pressure, and triglycerides, and reduce the frequency of medications needed. Unfortunately, a large proportion of these individuals are not ready to initiate weight efforts, making existing obesity management strategies less effective. Many digital health interventions aim at weight loss, but there is still limited evidence on their effectiveness in changing weight loss behavior, especially in adults with T2D.

OBJECTIVE

This study aims to develop and validate "Chance2Act," a new web-based intervention, designed specifically to facilitate behavioral change in adults with T2D with obesity who are not ready to act toward weight loss. Then, the effectiveness of the newly developed intervention will be determined from a nonrandomized controlled trial.

METHODS

A web-based intervention will be developed based on the Transtheoretical Model targeting adults with T2D with obesity who are not ready to change for weight loss. Phase 1 will involve the development and validation of the web-based health intervention module. In phase 2, a nonrandomized controlled trial will be conducted in 2 government health clinics selected by the investigator. This is an unblinded study with a parallel assignment (ie, intervention vs control [usual care] with an allocation ratio of 1:1). A total of 124 study participants will be recruited, of which 62 participants will receive the Chance2Act intervention in addition to the usual care. The primary outcome is the changes in an individual's readiness from a stage of not being ready to change (precontemplation, contemplation, or preparation stage) to being ready for weight loss (action stage). The secondary outcomes include changes in self-efficacy, decisional balance, family support for weight loss, BMI, waist circumference, and body fat composition.

RESULTS

The phase 1 study will reveal the intervention's validity through the Content Validity Index and Face Validity Index, considering it valid if both indices exceed 0.83. The effectiveness of the intervention will be determined in phase 2, where the differences within and between groups will be analyzed in terms of the improvement of stages of change and all secondary outcomes as defined in the methodology. Data analysis for phase 2 will commence in 2024, with the anticipated publication of results in March 2024.

CONCLUSIONS

If proven effective, the result of the study may give valuable insights into the effective behavioral modification strategies for a web-based intervention targeting adults with T2D with obesity but not yet ready to change for weight loss. This intervention may be replicated or adopted in different settings, focusing on behavioral modification support that patients need. This study offers a deeper understanding of the application of behavior change techniques for a more holistic approach to obesity care in T2D.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05736536; https://clinicaltrials.gov/study/NCT05736536.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/48313.

A study protocol for a pilot randomized controlled trial to evaluate the effectiveness of a gene-based nutrition and lifestyle recommendation for weight management among adults: the MyGeneMyDiet® study

Introduction

Managing nutrition and lifestyle practices, nutrition phenotypes, and the genome forms the foundation of precision nutrition. Precision nutrition focuses on metabolic variability among individuals, and one approach to achieving its goals is to integrate gene-based nutrition and lifestyle recommendations in nutrition practice. However, scientific evidence proving the effectiveness of such recommendations is limited. This study will examine whether providing nutrition and lifestyle recommendations based on individual genotype can lead to better weight loss, along with reduction in body mass index (BMI), waist circumference, and body fat percentage among overweight and obese adults.

Methods and analysis

A parallel group, single-blind, randomized controlled trial will be conducted. Sixty-two overweight/obese individuals aged 19-59 years old will be recruited. Participants will be randomly allocated to either the intervention (n = 31) or the control arm (n = 31). Participants in the intervention group will receive the MyGeneMyDiet® Recommendation for Weight Management, a gene-based nutrition and lifestyle recommendation that was developed based on existing evidence of the effects of FTO rs9939609 on body weight, BMI, and physical activity; UCP1 rs1800592 on calorie intake; and TCF7L2 rs7903146 on dietary fat intake. Participants in the control group will receive the standard recommendations for weight management. The primary outcomes will be the differences in weight, BMI, waist circumference, and body fat percentage between arms in both the active phase (6 months) and inactive phase (last 6 months) of the trial. Participants in both arms will be evaluated at baseline and in months 3, 6, 9, and 12.

Discussion

To the best of our knowledge, this will be the first gene-based intervention that will adopt a phase of intensive nutrition counseling, followed by a simulation of a free-living state to determine adherence to a gene-based recommendation. This study will contribute to the future implementation of precision nutrition interventions by providing evidence on the effectiveness of a gene-based nutrition and lifestyle recommendation for weight loss.

Clinical trial registration

clinicaltrials.gov, identifier [NCT05098899].

Partial Meal Replacement for Weight Loss after Stroke: Results of a Pilot Clinical Trial

INTRODUCTION

Over half of patients with acute ischemic stroke are overweight or obese as defined by a body mass index (BMI) ≥25 kg/m2. Professional and government agencies recommend weight management for these persons to improve risk factors for cardiovascular disease, including hypertension, dyslipidemia, vascular inflammation, and diabetes. However, approaches to weight loss have not been adequately tested specifically in patients with stroke. In anticipation of a larger trial with vascular or functional outcomes, we tested the feasibility and safety of a 12-week partial meal replacement (PMR) intervention for weight loss in overweight or obese patients with a recent ischemic stroke.

METHODS

This randomized open-label trial enrolled participants from December 2019 to February 2021 (with hiatus from March to August 2020 due to COVID-19 pandemic restrictions on research). Eligible patients had a recent ischemic stroke and BMI 27-49.9 kg/m2. Patients were randomized to a PMR diet (OPTAVIA® Optimal Weight 4 & 2 & 1 Plan®) plus standard care (SC) or SC alone. The PMR diet consisted of four meal replacements supplied to participants, two meals with lean protein and vegetables (self-prepared or supplied), and a healthy snack (also self-prepared or supplied). The PMR diet provided 1,100-1,300 calories per day. SC consisted of one instructional session on a healthy diet. Co-primary outcomes were ≥5% weight loss at 12 weeks and to identify barriers to successful weight loss among participants assigned to PMR. Safety outcomes included hospitalization, falls, pneumonia, or hypoglycemia requiring treatment by self or others. Due to the COVID-19 pandemic, study visits after August 2020 were by remote communication.

RESULTS

We enrolled 38 patients from two institutions. Two patients in each arm were lost and could not be included in outcome analyses. At 12 weeks, 9/17 patients in the PMR group and 2/17 patients in the SC group achieved ≥5% weight loss (52.9% vs. 11.9%; Fisher's exact p = 0.03). Mean percent weight change in the PMR group was -3.0% (SD 13.7) and -2.6% (SD 3.4) in the SC group (Wilcoxon rank-sum p = 0.17). No adverse events were attributed to study participation. Some participants had difficulty completing home monitoring of weight. In the PMR group, participants reported that food cravings and dislike for some food products were barriers to weight loss.

CONCLUSION

A PMR diet after ischemic stroke is feasible, safe, and effective for weight loss. In future trials, in-person or improved remote outcome monitoring may reduce anthropometric data variation.

Targeting Obesity to Optimize Weight Loss in Cardiac Rehabilitation: A PILOT STUDY

PURPOSE

Cardiac rehabilitation (CR) programs are integral in the treatment of coronary heart disease (CHD). However, most programs do not incorporate structured, evidence-based obesity treatment, potentially limiting efficacy for the large number of CHD patients with overweight/obesity. This pilot study determined the feasibility of adding a behavioral weight loss intervention during standard CR.

METHODS

Adults aged ≥40 yr with CHD and overweight/obesity were randomized to 6 mo of CR alone or CR plus a behavioral weight loss program incorporating meal replacements and individual dietary counseling (CR + WL). Body weight, adiposity, cardiometabolic risk factors, self-efficacy for eating, and stages and processes of change for weight management (S-Weight, P-Weight) were assessed at baseline and during follow-up.

RESULTS

Thirty-eight participants (64.5 ± 7.9 yr, 24% female, 16% Black/Hispanic) were enrolled over 18 mo. Retention was high, with 95% of participants completing the 6-mo follow-up visit. Participants attended ∼58% of the prescribed exercise sessions, and those in the CR + WL group attended 98% of the prescribed weight loss sessions. The CR + WL group lost significantly more weight than the CR group (6.4 ± 4.7% vs 1.2 ± 3.0%, P = .001), and there were significant treatment effects for total/regional adiposity, eating self-efficacy, and P-weight scores (all P values < .05). Overall, greater weight loss was associated with improvements in self-efficacy ( P = .014) and P-weight scores for weight consequences evaluation ( P = .007) and weight management actions ( P = .04).

CONCLUSIONS

A behavioral weight loss intervention during CR is feasible and safe, leading to greater weight and fat loss and related improvements in weight maintenance behaviors in overweight/obese adults with CHD.

The use of audio self-hypnosis to promote weight loss using the transtheoretical model of change: a randomized clinical pilot trial

Background

Few studies suggest the use of hypnosis in weight loss may be beneficial, especially when in conjunction with other lifestyle modifications or cognitive behavioral therapy. The primary aim of this study was to determine the ability of self-hypnosis audiotape to promote weight loss by measuring its effects on the Transtheoretical Model (TTM) of change stages and processes.

Methods

This study is a 3-week randomized double-blinded parallel controlled trial among adults who have overweight or obesity. The intervention group listened to a self-hypnosis audio file while the control group listened to a placebo audio file.

Results

Forty-six participants completed the 3-week follow-up visit. There was no association between progression across stages of change and self-hypnosis (X2(2, 46) = 1.909, p-value = 0.580). Gender, baseline BMD, and baseline S-weight had no effect on the association between stage change progression and self-hypnosis. The mean difference in weight at 3 weeks was -0.63 ± 0.43 kg in the hypnosis group and 0.0 ± 1.5 kg in the control group, independent t-test, p = 0.148.

Conclusion

Self-hypnosis was not associated with a progression in the TTM's stages of change or with weight loss after 3 weeks. As this pilot study was underpowered, further research with larger sample size and an examination of the effect of various self-hypnosis content and duration is recommended.

Description of a Hybrid Mindfulness-Integrated Multidisciplinary Workplace Weight Management Intervention Module ‘Mind-SLIMSHAPE’ Using the TIDieR Checklist

Published reports of workplace-based weight management interventions are often poorly described and are focused on dietary, physical, and behavioral management. These strategies are often unsustainable and only have short-term effectiveness. The Mind-SLIMSHAPE^TM is a mindfulness-integrated multidisciplinary intervention developed to address overweight and obesity problems among desk-bound employees while improving weight-related behavior through mindfulness meditation and mindful eating exercises. The integration of mindfulness and mindful eating aims to improve the individual’s focus on the present and heighten their sensitivity towards internal and external eating cues. The aim of this article is to describe the Mind-SLIMSHAPE^TM intervention program using The Template for Intervention Description and Replication (TIDieR) checklist. The Mind-SLIMSHAPE^TM module is a 24-week intervention program that was delivered in a quasi-experimental study among employees with BMI ≥ 25.0 kg/m² in a selected higher learning institution. The module was delivered via hybrid sessions that included both face-to-face and virtual online sessions. The novelty of our description includes summaries of each intervention component with its intensity, details of the theory grounded for this program, and the rationale for the intervention components. The Mind-SLIMSHAPE^TM module is ready to be implemented and replicated in a similar setting with possible refinement and enhancement of the mindfulness and mindful eating elements.

Mobile health plus community health worker support for weight management among public housing residents (Path to Health): A randomized controlled trial protocol

Interventions delivered by mobile devices (mHealth interventions) have the potential to increase access to weight management treatment in low-income populations. However, little prior research has examined effects of mHealth programming plus phone-based community health worker (CHW) support for weight management among public housing residents. For our intervention, we first interacted with a community advisory board to collect feedback on proposed intervention components. Transcripts from 5 advisory board meetings were coded and qualitative data was organized into themes. We used these data to inform our ongoing trial, in which public housing residents are randomized to one of three different groups: phone text messaging and digital self-weighing (mHealth only); mHealth intervention plus CHW behavioral phone counseling (mHealth+CHW); or assessment only to evaluate their differential effects on weight loss at 6- and 12-month follow-up. We will examine changes in diet and physical activity behaviors as well as potential mediating and moderating factors. Results of this trial could provide support for technology-based weight management interventions which may have greater potential for scalability and long-term dissemination than face-to-face programming. Clinical Trial Registration Number: NCT04852042.

Assessing the user experience and usability of the PRECIOUS system: a randomized controlled trial in obese patients

Objective To assess users' usability, satisfaction, acceptance and effectiveness of the PRECIOUS system to promote behavior change toward healthier lifestyles. Design: Thirty-one adult patients with BMI>30 (M = 44.23, SD = 5.91) were recruited and randomized into three conditions for a longitudinal study (3 months length): 1) Control group (TAU + biofeedback + follow-ups); 2) PRECIOUS only (app + biofeedback + follow-ups); 3) PRECIOUS + MI (app + biofeedback + motivational interviewing follow-ups). Main Outcome Measures: Usability, satisfaction, acceptance and effectiveness of PRECIOUS, and stages of change (S-Weight questionnaire). Results: The system was described as easy to use, flexible, fairly satisfying and good as a preventive health system. Participants rated biofeedback and the Physical Activity module as the most satisfying features. However, participants were unsatisfied with the Diet module. All additional features received acceptable scores in terms of satisfaction. Despite this, the PRECIOUS only group reported that they would probably recommend the system to others because it meets its purposes quite well. Conclusion: PRECIOUS was found a usable and acceptable solution, although improving several features in the Diet module in successive versions of the app would promote sustained use and satisfaction among users, possibly increasing its effectiveness in promoting healthier lifestyles. Abbreviations: ADA American Diabetes Association; BG2: BodyGuard2; BMI: Body Mass Index; CBT: Cognitive-behavioral therapy; EMA: Ecological Momentary Assessment; eHealth: Electronic health; mHealth: Mobile health; MI: Motivational interviewing; NCD: Non-communicable diseases; PA: Physical activity; PRECIOUS: PREventive Care Infrastructure based On Ubiquitous Sensing.

Enhanced Enrollment in the National Diabetes Prevention Program to Increase Engagement and Weight Loss for the Underserved: Protocol for a Randomized Controlled Trial

Background

Type 2 diabetes affects 9.4% of US adults with higher rates among racial and ethnic minorities and individuals of low socioeconomic status. The National Diabetes Prevention Program (NDPP) is an evidence-based and widely disseminated behavioral intervention to reduce diabetes incidence through modest weight loss. However, retention in the yearlong NDPP is problematic and leads to suboptimal weight loss, especially among diverse, underserved populations. Strategies to improve NDPP engagement and weight loss are needed urgently. Pilot results of the pre-NDPP, a novel enhancement to enrollment in the NDPP based on the Health Belief Model, were highly successful in a nonrandomized cohort study among 1140 racially diverse, predominately low-income participants. A total of 75 presession participants had doubled attendance and weight loss as compared with earlier participants who did not receive presessions. On the basis of these promising results, we are conducting a randomized controlled trial (RCT) to determine whether pre-NDPP reliably improves NDPP outcomes, as reported on ClinicalTrials.gov.

Objective

This study aims to (1) conduct an RCT comparing NDPP attendance and weight loss outcomes between participants who receive pre-NDPP versus direct enrollment into the NDPP (usual care), (2) examine potential effect mediators (perceived risk for developing diabetes and self-efficacy and readiness for weight control) and moderators (race and ethnicity; income level), and (3) evaluate implementation factors, including cost and projected return on investment.

Methods

This two-arm RCT will compare outcomes among diverse, predominately low-income participants who receive pre-NDPP versus direct enrollment into the NDPP (usual care). This is a type 1 hybrid effectiveness-implementation design to determine clinical effectiveness through an RCT, while assessing factors that may impact future pre-NDPP dissemination and implementation, including cost. Our primary research question is whether pre-NDPP improves NDPP attendance and weight loss compared with standard NDPP delivery.

Results

This project was funded in April 2019. Recruitment is underway as of July 2019. Initial participants began the intervention in October 2019. Data analysis and results reporting are expected to be completed in 2024.

Conclusions

This RCT of pre-NDPP may lead to future dissemination of a scalable, evidence-based strategy to improve success of the NDPP, reduce disparities in NDPP effectiveness, and help prevent type 2 diabetes across the country.

Trial Registration

ClinicalTrials.gov NCT04022499; https://clinicaltrials.gov/ct2/show/NCT04022499.

International Registered Report Identifier (IRRID)

PRR1-10.2196/15499

Assessing Motivational Stages and Processes of Change for Weight Management Around Bariatric Surgery: a Multicenter Study

INTRODUCTION/PURPOSE

The assessment of the patients' motivation as a predictor of behavioral change via five stages (pre-contemplation, contemplation, preparation, action, and maintenance) and four processes (emotional re-evaluation, weight management actions, environmental restructuring, and weight consequences evaluation) of change.

MATERIALS/METHODS

A total of 542 participants (251 waiting for bariatric surgery (BS), 90 undergoing BS, and 201 controls) completed the Stages (S-Weight) and Processes (P-Weight) of Change in Overweight and Obese People questionnaires in a multicenter cross-sectional study.

RESULTS

A higher percentage of subjects seeking BS (31.7%) were in the action stage (16.7% of post-BS patients, p < 0.001; 14.9% of controls, p < 0.001). The referred body mass index (BMI) reduction was higher in subjects in active stages (3.6 ± 4.4 kg/m² in maintenance versus 1.4 ± 1.4 kg/m² in contemplation, p < 0.001). In the P-Weight questionnaire, patients looking for BS scored significant higher in the four processes of change than controls. In addition, a positive and significantly correlation between BMI and the four processes was observed. In the stepwise multivariate analysis, BMI and the S-Weight allocation were constantly associated with the four processes of change.

CONCLUSION

Obesity is accompanied by a modifying behavioral stage, suggesting that subjects before BS are seriously thinking about overcoming excess weight. To identify subjects on the waiting list for BS who will be more receptive to weight lost interventions remains a challenge.

Text messaging as an intervention for weight loss in emerging adults

BACKGROUND AND PURPOSE

Rates of overweight and obesity in emerging adults are rapidly increasing and associated with many chronic illnesses, quality of life concerns, and increased health care spending. Effective weight management interventions are needed for this population. The purpose of this study was to examine effects of a text-messaging weight loss intervention on motivation, stage of change for weight loss, and BMI.

METHODS

Overweight and obese emerging adults were enrolled (n = 188) and randomized to control or intervention groups. Weight loss information was delivered via a website to both groups. The intervention group also received daily weight loss-related text messages. Motivation, stage of change, and BMI were assessed online, via self-report at baseline, 4, and 8 weeks.

CONCLUSIONS

Ninety-five participants were included in the final data analysis. There was a significant increase in motivation and stage of change and decrease in BMI over the study duration, with no significant differences between groups.

IMPLICATIONS FOR PRACTICE

Nurse practitioners are well positioned to provide innovative weight loss interventions in a variety of settings. These results provide important insights for the design of effective weight loss treatment for emerging adults and support the use of web-based and text message-based interventions.

What predicts regression from pre-diabetes to normal glucose regulation following a primary care nurse-delivered dietary intervention? A study protocol for a prospective cohort study

INTRODUCTION

Pre-diabetes is a high-risk state for the development of type 2 diabetes mellitus (T2DM) and cardiovascular disease. Regression to normoglycaemia, even if transient, significantly reduces the risk of developing T2DM. The primary aim of this mixed-methods study is to determine if there are clinically relevant differences among those with pre-diabetes and excess weight who regress to normoglycaemia, those who have persistent pre-diabetes and those who progress to T2DM following participation in a 6-month primary care nurse-delivered pre-diabetes dietary intervention. Incidence of T2DM at 2 years will be examined.

METHODS AND ANALYSIS

Four hundred participants with pre-diabetes (New Zealand definition glycated haemoglobin 41-49 mmol/mol) and a body mass index >25 kg/m² will be recruited through eight primary care practices in Hawke's Bay, New Zealand. Trained primary care nurses will deliver a 6-month structured dietary intervention, followed by quarterly reviews for 18 months post-intervention. Clinical data, data on lifestyle factors and health-related quality of life (HR-QoL) and blood samples will be collected at baseline, 6 months, 12 months and 24 months. Sixty participants purposefully selected will complete a semi-structured interview following the 6-month intervention. Poisson regression with robust standard errors and clustered by practice will be used to identify predictors of regression or progression at 6 months, and risk factors for developing T2DM at 2 years. Qualitative data will be analysed thematically. Changes in HR-QoL will be described and potential cost savings will be estimated from a funder's perspective at 2 years.

ETHICS AND DISSEMINATION

This study was approved by the Northern A Health and Disability Ethics Committee, New Zealand (Ethics Reference: 17/NTA/24). Study results will be presented to participants, published in peer-reviewed journals and presented at relevant conferences.

TRIAL REGISTRATION NUMBER

ACTRN12617000591358; Pre-results.

The Barcelona Orthorexia Scale (BOS): development process using the Delphi method

PURPOSE

Orthorexia nervosa is a currently investigated eating disorder proposed by US physician Steve Bratman, defined as pathological fixation on eating healthy food. This study aimed to develop, by consensus of experts, the basic items for a new questionnaire to evaluate some defining psychological features of orthorexia nervosa in English and Spanish language, the so-called Barcelona Orthorexia Scale (BOS).

METHODS

The initial item pool was composed of 105 items divided into six different content areas. To analyse the content of the items, a three-round Delphi study was developed, in which participants had to evaluate the representativeness and clarity of each item. Participants were chosen because of their knowledge on orthorexia and/or eating disorders.

RESULTS

58 experts, from 17 different countries, participated in the initial round and 30 in the last round. Items were added, rephrased, changed into another content area, modified or eliminated according to the participants' suggestions, partly due to the group's response, analysed statistically, and partly due to participants' recommendations.

CONCLUSIONS

64 items were obtained, with two versions in Spanish and English. The future BOS aims to provide a possible solution to the shortage of valid instruments to evaluate psychological features of orthorexia and to promote research on this field. Further analysis regarding validity and reliability is necessary to prove the BOS' value on this matter.

Caregiver's readiness for change as a predictor of outcome and attendance in an intervention programme for children and adolescents with obesity: a secondary data analysis

OBJECTIVE/DESIGN

It remains unclear as to the efficacy of readiness for change measurements in child and adolescent obesity intervention programmes. This observational study aimed to determine whether the caregiver's stage of change could predict outcome and adherence to treatment in an intensive intervention programme for children and adolescents with obesity.

SETTING

Participants were from the Whānau Pakari randomised clinical trial, a community based multi-disciplinary intervention programme for obesity in Taranaki, New Zealand.

PARTICIPANTS

Eligible participants (recruited January 2012 to August 2014) were aged 5-16 years and had a body mass index (BMI) ≥98th centile or BMI >91st centile with weight-related comorbidities.

INTERVENTIONS

This study only assessed participants randomised to the high-intensity intervention programme (6-month assessments with weekly group sessions for 12 months) given attendance data were required (n=96).

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary trial outcome was BMI SD score (SDS). Secondary outcome measures included indices such as fruit and vegetable intake, 550-m run/walk time and quality of life scores. At baseline assessment, participants (if >11 years old) and their accompanying adult were assessed for readiness to make healthy lifestyle change.

RESULTS

A quantitative measure of stage of change in caregivers was not a predictor of primary or secondary outcomes (change in BMI SDS pre-contemplation/contemplation -0.08, 95% CI -0.18 to 0.03, action -0.16, 95% CI -0.27 to -0.05, p=0.27), or overall attendance in the weekly activity sessions (40.0% vs 37.1%, respectively, p=0.54) in the child or adolescent.

CONCLUSIONS

Caregiver's stage of change was not a predictor of success in this multi-disciplinary assessment and intervention programme for children and adolescents with obesity. Future research needs to determine participants' factors for success.

TRIAL REGISTRATION NUMBER

ANZCTR12611000862943; Post-results.

A Self-Directed Mobile Intervention (WaznApp) to Promote Weight Control Among Employees at a Lebanese University: Protocol for a Feasibility Pilot Randomized Controlled Trial

Background

Overweight and obesity have become major health problems globally with more than 1.9 billion overweight adults. In Lebanon, the prevalence of obesity and overweight is 65.4% combined. Risk factors of obesity and overweight are preventable and can be addressed by modifications in the environment and in an individual’s lifestyle. Mobile technologies are increasingly used in behavioral, self-directed weight management interventions, providing users with additional opportunities to attain weight control (weight loss, weight gain prevention, etc). Mobile apps may allow for the delivery of Just-in-Time Adaptive Interventions (JITAIs), which provide support through skill building, emotional support, and instrumental support, following the participants’ progress. A few commercially available apps offer JITAI features, but no studies have tested their efficacy.

Objective

The primary objective of this study is to examine the feasibility of a self-directed weight loss intervention, targeting employees of an academic institution, using a virtual coaching app with JITAI features (Lark) and a self-help calorie-counting app (MyFitnessPal). The secondary objective is to estimate the effects of the intervention on main study outcomes.

Methods

This study is a single-center, parallel, randomized controlled trial with 2 study arms (intervention and control). Participants will be randomly allocated in equal proportions to the intervention (Lark) and control groups (MyFitnessPal). To be eligible for this study, participants must be employed full- or part-time at the university or its medical center, able to read English, have a smartphone, and be interested in controlling their weight. Recruitment strategies entail email invitations, printed posters, and social media postings. We will assess quantitative rates of recruitment, adherence, and retention, self-reported app quality using the user version of the Mobile App Rating Scale. We will also assess changes in weight-related outcomes (absolute weight and waist circumference), behavioral outcomes (physical activity and diet), and cognitive factors (motivation to participate in the trial and to manage weight).

Results

WaznApp was funded in June 2017, and recruitment started in March 2018.

Conclusions

This study will provide information as to whether the selected mobile apps offer a feasible solution for promoting weight management in an academic workplace. The results will inform a larger trial whose results might be replicated in similar workplaces in Lebanon and the Middle East and North Africa region, and will be used as a benchmark for further investigations in other settings and similar target groups.

Trial Registration

ClinicalTrials.gov NCT03321331; https://clinicaltrials.gov/ct2/show/NCT03321331 (Archived by WebCite at http://www.webcitation.org/6ys9NOLo5)

Registered Report Identifier

RR1-10.2196/9793

The Church Bridge Project: An Academic-Community Perspective of a Church-Based Weight Management Pilot Intervention among Young Adult African Americans

BACKGROUND

Churches are effective community partners and settings to address weight management among African Americans. There is limited information on the use of churches to reach young adult populations and church collaborations with primary care clinics.

OBJECTIVES

The Church Bridge Project represents a community-academic partnership that presents the recruitment process of a church-based weight management intervention and describes baseline data of participants recruited from churches and primary care providers. We also discuss research contributions, challenges and limitations, study applicability, and practice implications from an academic and community perspective.

METHODS

Church leaders were involved in the entire research process. The theory-driven intervention included 12 diabetes prevention program-adapted education and motivational interviewing (MI)-guided sessions. Participants were recruited through primary care providers and church leaders. Demographics, medical and weight history, stage of change for weight loss, social support, and self-efficacy for diet and physical activity, weight, and girth circumferences were measured. Baseline descriptive data were analyzed.

RESULTS

Of 64 potential participants, 42 (65.6%) were enrolled in the study and 16 (25.0%) completed baseline data collection. No participants were recruited through primary care providers. Recruited participants were similar to the target population except for being all obese and mostly female. The mean ± SD age of participants was 34.31 ± 8.86 years with most reporting having more than a high school education (n = 14 [87.5%]), individual yearly income of less than $59,000 (n = 12 [75.0%]), and been married or living with a partner (n = 9 [56.3%]). Most reported a history of hypertension and an immediate family history of diabetes and hypertension. Most participants were classified as class III obesity.

CONCLUSIONS

Young adults and primary care providers are difficult to engage in church-based interventions. Church leaders were comfortable with a collaborate model for decision making, but not an empower model. Churches remain a successful method to reach African Americans; however, more research is needed to motivate young adults to participate in health intervention research.

Cultural Variables Underlying Obesity in Latino Men: Design, Rationale and Participant Characteristics from the Latino Men's Health Initiative

Overweight and obesity are associated with significant health problems and rates of obesity are high among Latino men. This paper describes the design, rationale and participant characteristics of the key demographic variables assessed in an NIH-funded study (R21-CA143636) addressing culture and several obesity-related variables (diet, physical activity, and body image) among Mexican and Puerto Rican men using a community-based participatory research framework. Participants completed objective measures (height, weight, body fat, hip, waist), a health and culture interview, a diet questionnaire, and used an accelerometer to measure their level of physical activity. A total of 203 participants completed the measures and the health and culture interview and 193 completed all study components. Puerto Ricans were older than Mexicans (p < .0001) and there were significant differences in marital status (p < .05), country of birth (p < .05), smoking (p < .05) and work status (p < .001). There were no significant differences in religion, education, health insurance, Body Mass Index, body fat, hip and waist measurements, and the language preference of the interview. Results have implications for the development of a future intervention that incorporates the role of cultural factors into a community participatory obesity intervention for Latino men.

A randomized controlled trial of an individualized nutrition counseling program matched with a transtheoretical model for overweight and obese females in Thailand

BACKGROUND/OBJECTIVE

Effective weight reduction remains a challenge throughout the world as the prevalence of obesity and its consequences are increasing. This study aimed to determine the effects of an individualized nutrition counseling program (IC) matched with a transtheoretical model (TTM) for overweight and obese subjects.

SUBJECTS/METHODS

Fifty overweight and obese subjects aged 19-60 years with a body mass index ≥ 23 kg/m² were enrolled in the weight reduction study. They were randomized into two groups: Intervention group received an IC matched with a TTM; control group received an educational handbook. Body weight (BW), body fat (BF), waist circumference (WC), waist to height ratio (WHtR), stages of change (SOC), processes of change (POC), food intake, and physical activity (PA) were assessed at baseline and at 4, 8, and 12 weeks after program initiation in both groups. All data were analyzed by intention-to-treat, using SPSS software for hypothesis testing.

RESULTS

Forty-five female subjects were included in the 12-week trial at Ramkhamhaeng Hospital, Bangkok, Thailand. The results showed significant weight loss (1.98 ± 1.75 kg; 3% loss of initial weight) in the intervention group at 12 weeks, compared to a 0.17 ± 1.67 kg loss in the control group. There were significant differences between intervention and control groups in BF mass (-1.68 ± 1.78, -0.04 ± 1.62 kg); percentage BF (-1.54 ± 2.11, 0.08 ± 2.05); WC (-5.35 ± 3.84, 0.13 ± 3.23 cm); WHtR (-0.0336 ± 0.02, -0.0004 ± 0.02), and energy consumption (-405.09 ± 431.31, -74.92 ± 499.54 kcal/day) in the intervention and control groups, respectively. Intragroup SOC was improved in both groups. The POC for the weight management action (WMA) process was significantly different with POC scores increasing by 16.00 ± 11.73 and 7.74 ± 14.97 in the intervention and the control groups, respectively. PA level did not change in either group.

CONCLUSIONS

The IC matched with a TTM resulted in reductions in BW, BF, and WC, thus reducing likely health risks by decreasing energy intake and inducing positive behavior changes while enhancing the WMA process.

PREventive Care Infrastructure based On Ubiquitous Sensing (PRECIOUS): A Study Protocol

Background

mHealth has experienced a huge growth during the last decade. It has been presented as a new and promising pathway to increase self-management of health and chronic conditions in several populations. One of the most prolific areas of mHealth has been healthy lifestyles promotion. However, few mobile apps have succeeded in engaging people and ensuring sustained use.

Objective

This paper describes the pilot test protocol of the PReventive Care Infrastructure based on Ubiquitous Sensing (PRECIOUS) project, aimed at validating the PRECIOUS system with end users. This system includes, within a motivational framework, the Bodyguard2 sensor (accelerometer with heart rate monitoring) and the PRECIOUS app.

Methods

This is a pilot experimental study targeting morbidly obese prediabetic patients who will be randomized to three conditions: (1) Group 1 - Control group (Treatment as usual with the endocrinologist and the nurse + Bodyguard2), (2) Group 2 - PRECIOUS system (Bodyguard2 + PRECIOUS app), and (3) Group 3 - PRECIOUS system (Bodyguard2 + PRECIOUS app + Motivational Interviewing). The duration of the study will be 3 months with scheduled follow-up appointments within the scope of the project at Weeks 3, 5, 8, and 12. During the study, several measures related to healthy lifestyles, weight management, and health-related quality of life will be collected to explore the effectiveness of PRECIOUS to foster behavior change, as well as user acceptance, usability, and satisfaction with the solution.

Results

Because of the encouraging results shown in similar scientific work analyzing health apps acceptance in clinical settings, we expect patients to widely accept and express satisfaction with PRECIOUS. We also expect to find acceptable usability of the preventive health solution. The recruitment of the pilot study has concluded with the inclusion of 31 morbidly obese prediabetic patients. Results are expected to be available in mid-2017.

Conclusions

Adopting and maintaining healthy habits may be challenging in people with chronic conditions who usually need regular support to ensure mid/long-term adherence to recommendations and behavior change. Thus, mHealth could become a powerful and efficient tool since it allows continuous communication with users and immediate feedback. The PRECIOUS system is an innovative preventive health care solution aimed at enhancing inner motivation from users to change their lifestyles and adopt healthier habits. PRECIOUS includes ubiquitous sensors and a scientifically grounded app to address three main components of health: physical activity, diet, and stress levels.

Trial Registration

Clinicaltrials.gov NCT02818790; https://clinicaltrials.gov/ct2/show/NCT02818790 (Archived by WebCite at http://www.webcitation.org/6qfzdfMoU)

Assessing motivation and readiness to change for weight management and control: an in-depth evaluation of three sets of instruments

It is highly recommended to promptly assess motivation and readiness to change (RTC) in individuals who wish to achieve significant lifestyle behavior changes in order to improve their health, overall quality of life, and well-being. In particular, motivation should be assessed for those who face the difficult task to maintain weight, which implies a double challenge: weight loss initially and its management subsequently. In fact, weight-control may be as problematic as smoking or drugs-taking cessation, since they all share the commonality of being highly refractory to change. This paper will examine three well-established tools following the Transtheoretical Model, specifically assessing RTC in weight management: the University of Rhode Island Change Assessment Scale, the S-Weight and the P-Weight and the Decisional Balance Inventory. Though their strengths and weaknesses may appear to be rather homogeneous and similar, the S-Weight and P-Weight are more efficient in assessing RTC in weight management and control. Assessing motivation and RTC may be a crucial step in promptly identifying psychological obstacles or resistance toward weight-management in overweight or obese hospitalized individuals, and it may contribute to provide a more effective weight-control treatment intervention.

Assessment of processes of change for weight management in a UK sample

OBJECTIVE

The present study aimed to validate the English version of the Processes of Change questionnaire in weight management (P-Weight).

METHODS

Participants were 1,087 UK adults, including people enrolled in a behavioural weight management programme, university students and an opportunistic sample. The mean age of the sample was 34.80 (SD = 13.56) years, and 83% were women. BMI ranged from 18.51 to 55.36 (mean = 25.92, SD = 6.26) kg/m(2). Participants completed both the stages and processes questionnaires in weight management (S-Weight and P-Weight), and subscales from the EDI-2 and EAT-40. A refined version of the P-Weight consisting of 32 items was obtained based on the item analysis.

RESULTS

The internal structure of the scale fitted a four-factor model, and statistically significant correlations with external measures supported the convergent validity of the scale.

CONCLUSION

The adequate psychometric properties of the P-Weight English version suggest that it could be a useful tool to tailor weight management interventions.

"Teens Talk Healthy Weight": the impact of a motivational digital video disc on parental knowledge of obesity-related diseases in an adolescent clinic

The purpose of the study was to investigate the impact of a 7-minute educational and motivational weight-management digital video disc (DVD) that uses real patient/parent testimonials and provider-patient interactions, on adolescent and parent knowledge of obesity-related diseases; readiness, motivation, and self-efficacy to lose weight; connectedness to care provider; and likelihood of return to clinic for follow-up care. A randomized controlled trial was conducted among 40 overweight/obese adolescent participants (22.5% male, 77.5% female, mean age=15.43 years) and their parents (n=38) who visited a referral-only adolescent clinic for the first time from October 2009 to March 2010. Adolescents were randomly assigned by a research assistant to standard care alone or standard care plus DVD. Standard care (protocol-driven medical and nutritional assessment and counseling) was provided to all adolescents by a registered dietitian nutritionist and physician or nurse practitioner. Adolescents in the intervention group also viewed the DVD. Adolescents and parents completed assessments pre- and post-clinic visit. Repeated measures analysis of covariance was used to evaluate group differences, while controlling for race/ethnicity and age. Parents who viewed the DVD experienced greater improvements in obesity-related disease knowledge than parents who did not view the DVD. Adolescents in both groups improved on measures of motivation to lose weight and dieting self-efficacy, based on pre and post-test questionnaires. A 7-minute educational and motivational DVD helped improve parent knowledge, but was not more powerful than standard care alone in changing other weight-related outcomes in this adolescent clinic. Because it led to increased parental knowledge, incorporating the DVD into clinical practice could also allow more time for health providers to focus on specific obesity-related treatment/education. Future research might examine whether the DVD has more utility in different settings, such as primary care.

The transtheoretical model in weight management: validation of the processes of change questionnaire

OBJECTIVE

The processes of change implied in weight management remain unclear. The present study aimed to identify these processes by validating a questionnaire designed to assess processes of change (the P-Weight) in line with the transtheoretical model. The relationship of processes of change with stages of change and other external variables is also examined.

METHODS

Participants were 723 people from community and clinical settings in Barcelona. Their mean age was 32.07 (SD = 14.55) years; most of them were women (75.0%), and their mean BMI was 26.47 (SD = 8.52) kg/m(2). They all completed the P-Weight and the stages of change questionnaire (S-Weight), both applied to weight management, as well as two subscales from the Eating Disorders Inventory-2 and Eating Attitudes Test-40 questionnaires about the concern with dieting.

RESULTS

A 34-item version of the P-Weight was obtained by means of a refinement process. The principal components analysis applied to half of the sample identified four processes of change. A confirmatory factor analysis was then carried out with the other half of the sample, revealing that the model of four freely correlated first-order factors showed the best fit (GFI = 0.988, AGFI = 0.986, NFI = 0.986, and SRMR = 0.0559). Corrected item-total correlations (0.322-0.865) and Cronbach's alpha coefficients (0.781-0.960) were adequate. The relationship between the P-Weight and the S-Weight and the concern with dieting measures from other questionnaires supported the validity of the scale.

CONCLUSION

The study identified processes of change involved in weight management and reports the adequate psychometric properties of the P-Weight. It also reveals the relationship between processes and stages of change and other external variables.