Implementation intentions for weight loss in college students with overweight and obesity: a proof-of-concept randomized controlled trial

Systematic Review of Easy-to-Learn Behavioral Interventions for Dietary Changes Among Young Adults

INTRODUCTION

Improving the diet quality of young adults may support chronic disease prevention. The approaches used and efficacy of promoting small dietary behavior changes through easy-to-learn (ETL) interventions (requiring no more than 1 hour to teach the behavior) among young adults have not yet been systematically reviewed.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 independent electronic searches across 6 databases were conducted to identify any articles describing ETL interventions among young adults (aged 18-35 years) and reporting dietary intake outcomes.

RESULTS

Among 9,538 articles identified, 9 studies met eligibility criteria. Five studies reported significant improvement in the selected dietary outcome. Of these, 3 studies used an implementation intentions approach, in which participants were given or asked to write out a simple dietary behavior directive and carry it on their person. Less than half of included studies were rated as positive for overall quality.

DISCUSSION

The available evidence suggests that ETL interventions targeting the dietary behaviors of young adults may be effective in improving dietary intake. Limitations of included studies were lack of follow-up after the intervention period and low generalizability.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Further dietary intervention studies targeting young adults should systematically evaluate the efficacy of ETL intervention approaches among diverse samples.

MOBILE Intervention Pilot Study in College Students With Elevated Blood Pressure

BACKGROUND

Hypertension is typically recognized in middle-aged and older adults but often overlooked in younger populations.

OBJECTIVE

We evaluated a mobile intervention for reducing blood pressure (BP) in college-age students for 28 days.

METHODS

Students with elevated BP or undiagnosed hypertension were assigned to an intervention or control group. All subjects completed baseline questionnaires and attended an educational session. For 28 days, intervention subjects sent their BP and motivation levels to the research team and completed assigned BP-reducing tasks. After 28 days, all subjects completed an exit interview.

RESULTS

We found a statistically significant decrease in BP in the intervention group only ( P = .001) but no statistical difference in sodium intake for either group. Mean hypertension knowledge increased in both groups but was only significant for the control group ( P = .001).

CONCLUSIONS

The results provide preliminary data on BP reduction with greater impact on the intervention group.

Could implementation intentions improve the efficacy of behavioral weight-loss treatment?

Although behavioral weight loss treatment can result in health benefits, the effects on weight loss are generally disappointing, with lost weight regained within a few years. Because these problems appear to be due to a failure to execute the strong weight control intentions formed during treatment, the use of implementation intentions has been suggested to bridge that intention-behavior gap. In contrast to behavioral intentions, implementation intentions specify the situation in which the behavior should be enacted. Although implementation intentions have generally been very effective in increasing the likelihood of goal attainment for a wide range of behaviors, results with regard to eating have been mixed. Especially disappointing have been the findings of a large study that added implementation intentions to a clinical weight loss treatment and found no effects either on weight loss or on weight loss maintenance (Knäuper et al., 2018). I argue that this failure is due to the use of implementation intentions that target specific eating behaviors. According to the goal conflict model of eating, implementation intentions are most effective if they prime the weight control goal; implementation intentions targeting specific behaviors do not reliably do that. I review evidence that the implementation intention to think of dieting when confronted with palatable food items primes weight control thoughts. It also reduces eating of primed foods and even result in weight loss.

Behaviour change techniques that constitute effective planning interventions to improve physical activity and diet behaviour for people with chronic conditions: a systematic review

OBJECTIVES

Action planning is a brief and effective behaviour change technique (BCT) to improve physical activity (PA) and diet behaviour (DB). This study aimed to identify critical BCTs and mechanisms of action (MoAs) to interpret the effectiveness of planning interventions based on the Health Action Process Approach (HAPA) model.

DESIGN

Systematic review.

DATA SOURCES

PubMed, Web of Science, CINAHL (EBSCO), PsycINFO (EBSCO), Psychology and Behavioural Sciences Collection (EBSCO), psyARTICLES and Medline were searched for studies from January 1990 to September 2021 published in English.

ELIGIBILITY CRITERIA

Experiment involving action planning intervention to improve PA or DB in community-dwelling adult patients with chronic conditions.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently coded the planning interventions into BCT combinations and MoA assemblies. Outcome was dichotomised according to the statistical power and Cohen's d. The Cochrane risk of bias assessment tool and the Risk of Bias in Nonrandomized Studies-of Interventions assessment tool were used to assess the quality of randomised controlled trials (RCTs) and non-RCTs, respectively.

RESULTS

From the 52 included studies, 46 BCTs were identified and linked to 21 MoAs. Long-term facilitators for planning intervention included 'self-monitoring of behaviour', 'problem solving', 'instruction on how to perform the behaviour' and 'adding objects to the environments'. The three most frequently occurring MoAs were 'intention', 'behavioural regulation', 'beliefs about capabilities'. The effective intervention groups had higher MoA scores that corresponded to the HAPA model constructs than the ineffective groups.

CONCLUSIONS

The findings from this review may inform scientific and effective planning intervention designs for community-dwelling people with chronic conditions in the future.

PROSPERO REGISTRATION NUMBER

CRD42021241227.

A Program for the Comprehensive Cognitive Training of Excess Weight (TRAINEP): The Study Protocol for A Randomized, Controlled Trial

Background: The available treatments for people with excess weight have shown small effects. Cognitive training has shown promising results, but most of the research focused on normal-weight university students and reported immediate results after a single training session. This parallel group, randomized, controlled trial aims to study the efficacy of a program for the comprehensive cognitive treatment of excess weight. Methods and Analysis: Participants will be 150 people with excess weight recruited through social media, who will be randomized into three groups: cognitive intervention, sham cognitive intervention, and treatment as usual. All assessment and intervention sessions will be online in groups of 5–6 participants. The three groups will attend a motivational interviewing session, and they will receive individualized diet and physical exercise guidelines throughout the program. The cognitive training will consist of four weekly sessions of approximately 60–90 min, each based on approach–avoidance bias training, inhibitory control training, implementation of intentions, and episodic future thinking, respectively. The main outcome measure will be a change in Body Mass Index (kg/m2). Secondary outcomes include changes in cognitive measures, eating and physical exercise behaviors, and anthropometric measures. Assessments will be conducted up to 6 months after the end of the program. In addition, data on the use of the health system will be collected to analyze the cost-effectiveness and the cost-utility of training. Linear mixed models will be used for statistical analysis. Findings of this study will expand the available evidence on cognitive interventions to reduce excess weight.

Making Specific Plan Improves Physical Activity and Healthy Eating for Community-Dwelling Patients With Chronic Conditions: A Systematic Review and Meta-Analysis

Background

Implementation intention formed by making a specific action plan has been proved effective in improving physical activity (PA) and dietary behavior (DB) for the general, healthy population, but there has been no meta-analysis of their effectiveness for patients with chronic conditions. This research aims to analyze several explanatory factors and overall effect of implementation intention on behavioral and health-related outcomes among community-dwelling patients.

Methods

We searched CIHNAL (EBSCO), PUBMED, Web of Science, Science Direct, SAGE Online, Springer Link, Taylor & Francis, Scopus, Wiley Online Library, CNKI, and five other databases for eligible studies. Random-effects meta-analysis was conducted to estimate effect sizes of implementation intention on outcomes, including PA, DB, weight, and body mass index. And the eligible studies were assessed by the Cochrane Collaboration's tool for risk of bias assessment. Sensitivity analysis adopted sequential algorithm and the p-curve analysis method.

Results

A total of 54 studies were identified. Significant small effect sizes of the intervention were found for PA [standard mean difference (SMD) 0.24, 95% confidence interval (CI) (0.10, 0.39)] and for the DB outcome [SMD -0.25, 95% CI (-0.34, -0.15)]. In moderation analysis, the intervention was more effective in improving PA for men (p < 0.001), older adults (p = 0.006), and obese/overweight patients with complications (p = 0.048) and when the intervention was delivered by a healthcare provider (p = 0.01).

Conclusion

Implementation intentions are effective in improving PA and DB for community dwelling patients with chronic conditions. The review provides evidence to support the future application of implementation intention intervention. Besides, the findings from this review offer different directions to enhance the effectiveness of this brief and potential intervention in improving patients' PA and DB.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=160491.

Where are we now? The intersection of healthy living medicine and social justice within our school systems

Alongside the tensions brought forth by the pandemic, such as health and safety concerns from transmission and economic insecurity, there was also a rise in racial and social tension, bringing issues of equity and justice to the forefront. Consequently, there has been a call for reform and an urgency for change in legal, political, economic, and healthcare spheres. Change only occurs through change, with a pivotal point to target the beginning stages in life which will have a greater likelihood to subsist throughout the lifecourse. The crossroads of healthy living medicine (HLM) and education are an appropriate context for necessary change. If healthy living medicine is to embody the ideals of social justice, then people need equal access to resources of well-being - physical, social, and emotional - in their school systems. This paper examines the current intersection of health and social justice within the school systems in the United States. It is both a critique of how school systems have not yet provided such an intersection and highlight those efforts that have proven valuable and successful in providing HLM resources to populations that are historically under-resourced and under-served. Ultimately, this paper looks to provide a path forward, providing ideas for sustainable, feasible, actionable change in school systems K-12 and in higher education.