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Petrone BL, Bartlett A, Jiang S, Korenek A, Vintila S, Tenekjian C, Yancy WS, David LA, Kleiner M. Metaproteomics and DNA metabarcoding as tools to assess dietary intake in humans. bioRxiv 2024:2024.04.09.588275. [PMID: 38645092 PMCID: PMC11030321 DOI: 10.1101/2024.04.09.588275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Objective biomarkers of food intake are a sought-after goal in nutrition research. Most biomarker development to date has focused on metabolites detected in blood, urine, skin or hair, but detection of consumed foods in stool has also been shown to be possible via DNA sequencing. An additional food macromolecule in stool that harbors sequence information is protein. However, the use of protein as an intake biomarker has only been explored to a very limited extent. Here, we evaluate and compare measurement of residual food-derived DNA and protein in stool as potential biomarkers of intake. We performed a pilot study of DNA sequencing-based metabarcoding (FoodSeq) and mass spectrometry-based metaproteomics in five individuals' stool sampled in short, longitudinal bursts accompanied by detailed diet records (n=27 total samples). Dietary data provided by stool DNA, stool protein, and written diet record independently identified a strong within-person dietary signature, identified similar food taxa, and had significantly similar global structure in two of the three pairwise comparisons between measurement techniques (DNA-to-protein and DNA-to-diet record). Metaproteomics identified proteins including myosin, ovalbumin, and beta-lactoglobulin that differentiated food tissue types like beef from dairy and chicken from egg, distinctions that were not possible by DNA alone. Overall, our results lay the groundwork for development of targeted metaproteomic assays for dietary assessment and demonstrate that diverse molecular components of food can be leveraged to study food intake using stool samples.
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Affiliation(s)
- Brianna L Petrone
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, United States
- Medical Scientist Training Program, Duke University School of Medicine, Durham, NC, United States
| | - Alexandria Bartlett
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, United States
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC, United States
| | - Sharon Jiang
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, United States
| | - Abigail Korenek
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC, United States
| | - Simina Vintila
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC, United States
| | | | - William S Yancy
- Duke Lifestyle and Weight Management Center, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Lawrence A David
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, United States
| | - Manuel Kleiner
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC, United States
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2
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Volek JS, Yancy WS, Gower BA, Phinney SD, Slavin J, Koutnik AP, Hurn M, Spinner J, Cucuzzella M, Hecht FM. Expert consensus on nutrition and lower-carbohydrate diets: An evidence- and equity-based approach to dietary guidance. Front Nutr 2024; 11:1376098. [PMID: 38487629 PMCID: PMC10937533 DOI: 10.3389/fnut.2024.1376098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
There is a substantial body of clinical evidence supporting the beneficial effects of lower-carbohydrate dietary patterns on multiple established risk factors associated with insulin resistance and cardiovascular diseases in adult populations. Nutrition and health researchers, clinical practitioners, and stakeholders gathered for, "The Scientific Forum on Nutrition, Wellness, and Lower-Carbohydrate Diets: An Evidence- and Equity-Based Approach to Dietary Guidance" to discuss the evidence base around lower-carbohydrate diets, health outcomes, and dietary guidance. Consensus statements were agreed upon to identify current areas of scientific agreement and spotlight gaps in research, education, and practice to help define and prioritize future pathways. Given the evidence base and considering that most American adults are living with at least one nutrition-related chronic disease, there was consensus that including a lower-carbohydrate dietary pattern as one part of the Dietary Guidelines for Americans could help promote health equity among the general population.
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Affiliation(s)
- Jeff S. Volek
- Department of Human Sciences, The Ohio State University, Columbus, OH, United States
| | - William S. Yancy
- Department of Medicine, Duke University, Durham, NC, United States
| | - Barbara A. Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Joanne Slavin
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN, United States
| | - Andrew P. Koutnik
- Sansum Diabetes Research Institute, Santa Barbara, CA, United States
| | - Michelle Hurn
- The Dietetian’s Dilemma, Portland, OR, United States
| | | | - Mark Cucuzzella
- Department of Family Medicine, West Virginia University, Martinsburg, WV, United States
| | - Frederick M. Hecht
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA, United States
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3
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Rechenmacher AJ, Yancy WS, Bolognesi MP, Ryan SP, Jiranek WA, Horn ME. Does Medically Supervised Weight Loss Prior to Total Knee Arthroplasty Improve Patient-Reported Pain and Physical Function? J Arthroplasty 2024; 39:350-354. [PMID: 37597821 DOI: 10.1016/j.arth.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Weight loss is commonly recommended before total knee arthroplasty (TKA) despite inconsistent evidence for better outcomes. This study sought to examine the impacts of preoperative weight loss on patient-reported and adverse outcomes among TKA patients supervised by a medical weight management clinic. METHODS This study retrospectively analyzed patients who underwent medical weight management supervision within 18 months before TKA comparing patients who did and did not have clinically relevant weight loss. Preoperative body mass indices, demographics, Patient-Reported Outcomes Measurement Information System physical function and pain interference scores, pain intensity scores, and adverse outcomes were extracted. Multivariable linear regressions were performed to determine if preoperative weight loss correlated with patient-reported outcomes after controlling for confounders. RESULTS There were 90 patients, 75.6% women, who had a mean age of 65 years (range, 42-82) and were analyzed. There were 51 (56.7%) patients who underwent clinically relevant weight loss with a mean weight loss of 10.4% and experienced no difference in adverse outcomes. Preoperative weight loss predicted significantly improved 3-month postoperative physical function (β = 15.2 [13.0-17.3], P < .001), but not pain interference (β = -18.9 [-57.1-19.4], P = .215) or pain intensity (β = -1.8 [-4.9-1.2], P = .222) scores. CONCLUSION We found that medically supervised preoperative weight loss predicted improvement in physical function 3 months after TKA. This weight loss caused no major adverse effects. Further research is needed to understand the causal relationships between preoperative weight loss, medical supervision, and outcome after TKA and to elucidate potential longer-term benefits in a larger sample.
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Affiliation(s)
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Maggie E Horn
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina
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Tong J, Duan R, Li R, Luo C, Moore JH, Zhu J, Foster GD, Volpp KG, Yancy WS, Shaw PA, Chen Y. Publisher Correction: Quantifying and correcting bias due to outcome dependent self-reported weights in longitudinal study of weight loss interventions. Sci Rep 2023; 13:22546. [PMID: 38110504 PMCID: PMC10728146 DOI: 10.1038/s41598-023-49737-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Affiliation(s)
- Jiayi Tong
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Rui Duan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Ruowang Li
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Jason H Moore
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Gary D Foster
- WW International, New York, NY, 10010, USA
- Center for Weight and eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kevin G Volpp
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - William S Yancy
- Department of Medicine, Duke University, Durham, NC, 27705, USA
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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5
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Rechenmacher AJ, Yancy WS, Bolognesi MP, Jiranek WA, Seyler TM, Horn ME. Does Preoperative Weight Loss Within 6 Months or 1 Year Change the Risk of Adverse Outcomes in Total Knee Arthroplasty by Initial Body Mass Index Classification? J Arthroplasty 2023; 38:2517-2522.e2. [PMID: 37331436 DOI: 10.1016/j.arth.2023.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND High body mass index (BMI) is associated with adverse outcomes after total knee arthroplasty (TKA). Thus, many patients are advised to lose weight before TKA. This study examined how weight loss before TKA is associated with adverse outcomes depending on patients' initial BMI. METHODS This was a retrospective study of 2,110 primary TKAs at a single academic center. Data on preoperative BMIs, demographics, comorbidities, and incidences of revision or prosthetic joint infection (PJI) were obtained. Multivariable logistic regressions segmented by patients' initial (1-year preoperative) BMI classifications were performed to determine if a > 5% BMI decrease from 1 year or 6 months preoperatively predicted PJI and revision controlling for patient age, race, sex, and Elixhauser comorbidity index. RESULTS Preoperative weight loss did not predict adverse outcomes for patients who had Obesity Class II or III. 6-month weight loss had greater odds of adverse outcomes than 1-year weight loss and most significantly predicted the occurrence of 1-year PJI (adjusted odds ratio: 6.55, P < .001) for patients who had Obesity Class 1 or lower. CONCLUSION This study does not show a statistically significant effect to patients who had Obesity Class II and III losing weight preoperatively with respect to PJI or revision. For patients who have Obesity Class I or lower pursuing TKA, future research should consider potential risks associated with weight loss. Further study is needed to determine if weight loss can be implemented as a safe and effective risk reduction strategy for specific BMI classes of TKA patients.
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Affiliation(s)
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Duke Diet & Fitness Center, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Maggie E Horn
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina
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6
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Tong J, Duan R, Li R, Luo C, Moore JH, Zhu J, Foster GD, Volpp KG, Yancy WS, Shaw PA, Chen Y. Quantifying and correcting bias due to outcome dependent self-reported weights in longitudinal study of weight loss interventions. Sci Rep 2023; 13:19078. [PMID: 37925516 PMCID: PMC10625563 DOI: 10.1038/s41598-023-41853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/31/2023] [Indexed: 11/06/2023] Open
Abstract
In response to the escalating global obesity crisis and its associated health and financial burdens, this paper presents a novel methodology for analyzing longitudinal weight loss data and assessing the effectiveness of financial incentives. Drawing from the Keep It Off trial-a three-arm randomized controlled study with 189 participants-we examined the potential impact of financial incentives on weight loss maintenance. Given that some participants choose not to weigh themselves because of small weight change or weight gains, which is a common phenomenon in many weight-loss studies, traditional methods, for example, the Generalized Estimating Equations (GEE) method tends to overestimate the effect size due to the assumption that data are missing completely at random. To address this challenge, we proposed a framework which can identify evidence of missing not at random and conduct bias correction using the estimating equation derived from pairwise composite likelihood. By analyzing the Keep It Off data, we found that the data in this trial are most likely characterized by non-random missingness. Notably, we also found that the enrollment time (i.e., duration time) would be positively associated with the weight loss maintenance after adjusting for the baseline participant characteristics (e.g., age, sex). Moreover, the lottery-based intervention was found to be more effective in weight loss maintenance compared with the direct payment intervention, though the difference was non-statistically significant. This framework's significance extends beyond weight loss research, offering a semi-parametric approach to assess missing data mechanisms and robustly explore associations between exposures (e.g., financial incentives) and key outcomes (e.g., weight loss maintenance). In essence, the proposed methodology provides a powerful toolkit for analyzing real-world longitudinal data, particularly in scenarios with data missing not at random, enriching comprehension of intricate dataset dynamics.
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Affiliation(s)
- Jiayi Tong
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Rui Duan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Ruowang Li
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Jason H Moore
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Gary D Foster
- WW International, New York, NY, 10010, USA
- Center for Weight and eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kevin G Volpp
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - William S Yancy
- Department of Medicine, Duke University, Durham, NC, 27705, USA
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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7
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Petrone BL, Aqeel A, Jiang S, Durand HK, Dallow EP, McCann JR, Dressman HK, Hu Z, Tenekjian CB, Yancy WS, Lin PH, Scialla JJ, Seed PC, Rawls JF, Armstrong SC, Stevens J, David LA. Diversity of plant DNA in stool is linked to dietary quality, age, and household income. Proc Natl Acad Sci U S A 2023; 120:e2304441120. [PMID: 37368926 PMCID: PMC10319039 DOI: 10.1073/pnas.2304441120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/10/2023] [Indexed: 06/29/2023] Open
Abstract
Eating a varied diet is a central tenet of good nutrition. Here, we develop a molecular tool to quantify human dietary plant diversity by applying DNA metabarcoding with the chloroplast trnL-P6 marker to 1,029 fecal samples from 324 participants across two interventional feeding studies and three observational cohorts. The number of plant taxa per sample (plant metabarcoding richness or pMR) correlated with recorded intakes in interventional diets and with indices calculated from a food frequency questionnaire in typical diets (ρ = 0.40 to 0.63). In adolescents unable to collect validated dietary survey data, trnL metabarcoding detected 111 plant taxa, with 86 consumed by more than one individual and four (wheat, chocolate, corn, and potato family) consumed by >70% of individuals. Adolescent pMR was associated with age and household income, replicating prior epidemiologic findings. Overall, trnL metabarcoding promises an objective and accurate measure of the number and types of plants consumed that is applicable to diverse human populations.
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Affiliation(s)
- Brianna L. Petrone
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC27710
- Medical Scientist Training Program, Duke University School of Medicine, Durham, NC27710
| | - Ammara Aqeel
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC27710
| | - Sharon Jiang
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC27710
| | - Heather K. Durand
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC27710
| | - Eric P. Dallow
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC27710
| | - Jessica R. McCann
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC27710
| | - Holly K. Dressman
- Duke Microbiome Core Facility, Center for Genomic and Computational Biology, Duke University, Durham, NC27710
| | - Zhengzheng Hu
- Duke Microbiome Core Facility, Center for Genomic and Computational Biology, Duke University, Durham, NC27710
| | | | - William S. Yancy
- Duke Lifestyle and Weight Management Center, Durham, NC27710
- Department of Medicine, Duke University School of Medicine, Durham, NC27710
| | - Pao-Hwa Lin
- Department of Medicine, Nephrology Division, Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC27705
| | - Julia J. Scialla
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA22903
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA22903
| | - Patrick C. Seed
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL60611
| | - John F. Rawls
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC27710
- Duke Microbiome Center, Duke University School of Medicine, Durham, NC27710
| | - Sarah C. Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC27710
| | - June Stevens
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC27599
| | - Lawrence A. David
- Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC27710
- Duke Microbiome Center, Duke University School of Medicine, Durham, NC27710
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8
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Gavin KL, Almeida EJ, Voils CI, Crane MM, Shaw R, Yancy WS, Pendergast J, Olsen MK. Comparison of weight captured via electronic health record and cellular scales to the gold‐standard clinical method. Obes Sci Pract 2023. [PMID: 37546286 PMCID: PMC10399518 DOI: 10.1002/osp4.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction Obtaining body weights remotely could improve feasibility of pragmatic trials. This investigation examined whether weights collected via cellular scale or electronic health record (EHR) correspond to gold standard in-person study weights. Methods The agreement of paired weight measurements from cellular scales were compared to study scales from a weight loss intervention and EHR-collected weights were compared to study scales from a weight loss maintenance intervention. Differential weight change estimates between intervention and control groups using both pragmatic methods were compared to study collected weight. In the Log2Lose feasibility weight loss trial, in-person weights were collected bi-weekly and compared to weights collected via cellular scales throughout the study period. In the MAINTAIN weight loss maintenance trial, in-person weights were collected at baseline, 14, 26, 42 and 56 weeks. All available weights from the EHR during the study period were obtained. Results On average, in Log2Lose cellular scale weights were 0.6 kg (95% CI: -2.9, 2.2) lower than in-person weights; in MAINTAIN, EHR weights were 2.8 kg (SE: -0.5, 6.0) higher than in-person weights. Estimated weight change using pragmatic methods and study scales in both studies were in the same direction and of similar magnitude. Conclusion Both methods can be used as cost-effective and real-world surrogates within a tolerable variability for the gold-standard. Trial registration NCT02691260; NCT01357551.
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Affiliation(s)
- Kara L. Gavin
- William S. Middleton Memorial Veterans Hospital Madison WI USA
- Department of Surgery University of Wisconsin Madison WI USA
| | | | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital Madison WI USA
- Department of Surgery University of Wisconsin Madison WI USA
| | - Melissa M. Crane
- Department of Family and Preventive Medicine Rush University Medical Center Chicago IL USA
| | - Ryan Shaw
- School of Nursing Duke University Durham NC USA
| | - William S. Yancy
- Duke Lifestyle and Weight Management Center and Department of Medicine Duke University Durham NC USA
| | - Jane Pendergast
- Department of Biostatistics and Bioinformatics Duke University School of Medicine Durham NC USA
| | - Maren K. Olsen
- Department of Biostatistics and Bioinformatics Duke University School of Medicine Durham NC USA
- Durham VA Medical Center Durham NC USA
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9
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Griauzde DH, O'Brien A, Yancy WS, Richardson CR, Krinock J, DeJonckheere M, Isaman DJM, Vanias K, Shopinski S, Saslow LR. Testing a very low-carbohydrate adaption of the Diabetes Prevention Program among adults with prediabetes: study protocol for the Lifestyle Education about prediabetes (LEAP) trial. Trials 2022; 23:827. [PMID: 36176003 PMCID: PMC9524018 DOI: 10.1186/s13063-022-06770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Center for Disease Control and Prevention's National Diabetes Prevention Program (NDPP) aims to help individuals with prediabetes avoid progression to type 2 diabetes mellitus (T2DM) through weight loss. Specifically, the NDPP teaches individuals to follow a low-fat, calorie-restricted diet and to engage in regular physical activity to achieve ≥ 5% body weight loss. Most NDPP participants, however, do not achieve this weight loss goal, and glycemic control remains largely unchanged. One promising opportunity to augment the NDPP's weight loss and glycemic effectiveness may be to teach participants to follow a very low-carbohydrate diet (VLCD), which can directly reduce post-prandial glycemia and facilitate weight loss by reducing circulating insulin and enabling lipolysis. To date, there have been no high-quality, randomized controlled trials to test whether a VLCD can prevent progression to T2DM among individuals with prediabetes. The aim of this study is to test the effectiveness of a VLCD version the NDPP (VLC-NDPP) versus the standard NDPP. We hypothesize the VLC-NDPP will demonstrate greater improvements in weight loss and glycemic control. METHODS We propose to conduct a 12-month, 1:1, randomized controlled trial that will assign 300 adults with overweight or obesity and prediabetes to either the NDPP or VLC-NDPP. The primary outcome will be glycemic control as measured by change in hemoglobin A1c (HbA1c) from baseline to 12 months. Secondary outcomes will include percent body weight change and changes in glycemic variability, inflammatory markers, lipids, and interim HbA1c. We will evaluate progression to T2DM and initiation of anti-hyperglycemic agents. We will conduct qualitative interviews among a purposive sample of participants to explore barriers to and facilitators of dietary adherence. The principal quantitative analysis will be intent-to-treat using hierarchical linear mixed effects models to assess differences over time. DISCUSSION The NDPP is the dominant public health strategy for T2DM prevention. Changing the program's dietary advice to include a carbohydrate-restricted eating pattern as an alternative option may enhance the program's effectiveness. If the VLC-NDPP shows promise, this trial would be a precursor to a multi-site trial with incident T2DM as the primary outcome. TRIAL REGISTRATION NCT05235425. Registered February 11, 2022.
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Affiliation(s)
- Dina H Griauzde
- Department of Internal Medicine, University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 16-371C, Ann Arbor, MI, 48109-2800, USA. .,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
| | - Alison O'Brien
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Caroline R Richardson
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jamie Krinock
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Deanna J M Isaman
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Kaitlyn Vanias
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | | | - Laura R Saslow
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
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10
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Miller HN, Voils CI, Cronin KA, Jeanes E, Hawley J, Porter LS, Adler RR, Sharp W, Pabich S, Gavin KL, Lewis MA, Johnson HM, Yancy WS, Gray KE, Shaw RJ. A Method to Deliver Automated and Tailored Intervention Content: 24-month Clinical Trial. JMIR Form Res 2022; 6:e38262. [PMID: 36066936 PMCID: PMC9490532 DOI: 10.2196/38262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background
The use of digital technologies and software allows for new opportunities to communicate and engage with research participants over time. When software is coupled with automation, we can engage with research participants in a reliable and affordable manner. Research Electronic Data Capture (REDCap), a browser-based software, has the capability to send automated text messages. This feature can be used to automate delivery of tailored intervention content to research participants in interventions, offering the potential to reduce costs and improve accessibility and scalability.
Objective
This study aimed to describe the development and use of 2 REDCap databases to deliver automated intervention content and communication to index participants and their partners (dyads) in a 2-arm, 24-month weight management trial, Partner2Lose.
Methods
Partner2Lose randomized individuals with overweight or obesity and cohabitating with a partner to a weight management intervention alone or with their partner. Two databases were developed to correspond to 2 study phases: one for weight loss initiation and one for weight loss maintenance and reminders. The weight loss initiation database was programmed to send participants (in both arms) and their partners (partner-assisted arm) tailored text messages during months 1-6 of the intervention to reinforce class content and support goal achievement. The weight maintenance and reminder database was programmed to send maintenance-related text messages to each participant (both arms) and their partners (partner-assisted arm) during months 7-18. It was also programmed to send text messages to all participants and partners over the course of the 24-month trial to remind them of group classes, dietary recall and physical activity tracking for assessments, and measurement visits. All text messages were delivered via Twilio and were unidirectional.
Results
Five cohorts, comprising 231 couples, were consented and randomized in the Partner2Lose trial. The databases will send 53,518 automated, tailored text messages during the trial, significantly reducing the need for staff to send and manage intervention content over 24 months. The cost of text messaging will be approximately US $450. Thus far, there is a 0.004% known error rate in text message delivery.
Conclusions
Our trial automated the delivery of tailored intervention content and communication using REDCap. The approach described provides a framework that can be used in future behavioral health interventions to create an accessible, reliable, and affordable method for intervention delivery and engagement that requires minimal trial-specific resources and personnel time.
Trial Registration
ClinicalTrials.gov NCT03801174; https://clinicaltrials.gov/ct2/show/NCT03801174?term=NCT03801174
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Affiliation(s)
- Hailey N Miller
- School of Nursing, Duke University, North Carolina, NC, United States
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Corrine I Voils
- Department of Surgery, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI, United States
- William S Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - Kate A Cronin
- William S Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - Elizabeth Jeanes
- William S Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - Jeffrey Hawley
- Duke Office of Clinical Research, School of Medicine, Duke University, Durham, NC, United States
| | - Laura S Porter
- School of Nursing, Duke University, North Carolina, NC, United States
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, United States
| | - Rachel R Adler
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
| | - Whitney Sharp
- Department of Surgery, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Samantha Pabich
- William S Middleton Memorial Veterans Hospital, Madison, WI, United States
- Department of Medicine, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Kara L Gavin
- Department of Surgery, School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI, United States
- William S Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - Megan A Lewis
- RTI International, Research Triangle Park, NC, United States
| | - Heather M Johnson
- Division of Cardiology, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
- Christine E Lynn Women's Health & Wellness Institute/Baptist Health South Florida, Boca Raton, FL, United States
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Kristen E Gray
- Health Services Research & Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Ryan J Shaw
- School of Nursing, Duke University, North Carolina, NC, United States
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11
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Sagalla N, Yancy WS, Edelman D, Jeffreys AS, Coffman CJ, Voils CI, Alexopoulos AS, Maciejewski ML, Dar M, Crowley MJ. Factors associated with non-adherence to insulin and non-insulin medications in patients with poorly controlled diabetes. Chronic Illn 2022; 18:398-409. [PMID: 33100020 PMCID: PMC8995079 DOI: 10.1177/1742395320968627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate differences in factors associated with self-reported medication non-adherence to insulin and non-insulin medications in patients with uncontrolled type 2 diabetes. METHODS In this secondary analysis of a randomized trial in patients with obesity and uncontrolled type 2 diabetes, multivariable logistic regression was used to evaluate associations between several clinical factors (measured with survey questionnaires at study baseline) and self-reported non-adherence to insulin and non-insulin medications. RESULTS Among 263 patients, reported non-adherence was 62% (52% for insulin, 55% for non-insulin medications). Reported non-adherence to non-insulin medications was less likely in white versus non-white patients (odds ratio (OR) = 0.42; 95%CI: 0.22,0.80) and with each additional medication taken (OR = 0.75; 95%CI: 0.61,0.93). Non-adherence to non-insulin medications was more likely with each point increase in a measure of diabetes medication intensity (OR = 1.43; 95%CI: 1.01,2.03), the Problem Areas in Diabetes (PAID) score (OR = 1.06; 95%CI: 1.02,1.12), and in men versus women (OR = 3.03; 95%CI: 1.06,8.65). For insulin, reporting non-adherence was more likely (OR = 1.02; 95%CI: 1.00,1.04) with each point increase in the PAID. DISCUSSION Despite similar overall rates of reported non-adherence to insulin and non-insulin medications, factors associated with reported non-adherence to each medication type differed. These findings may help tailor approaches to supporting adherence in patients using different types of diabetes medications.
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Affiliation(s)
- Nicole Sagalla
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, USA
| | - William S Yancy
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, USA.,Duke Diet and Fitness Center, Durham, USA
| | - David Edelman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, USA
| | - Amy S Jeffreys
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, USA.,Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, USA
| | - Anastasia-Stefania Alexopoulos
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, USA
| | - Moahad Dar
- Division of Endocrinology and Metabolism, East Carolina University, Greenville, USA.,Greenville Veterans Affairs Health Care Center, Greenville, USA
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, USA
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12
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Ludwig DS, Aronne LJ, Astrup A, de Cabo R, Cantley LC, Friedman MI, Heymsfield SB, Johnson JD, King JC, Krauss RM, Lieberman DE, Taubes G, Volek JS, Westman EC, Willett WC, Yancy WS, Ebbeling CB. Reply to A Drewnowski et al, O Devinsky, D A Booth and E L Gibson, and D J Millward. Am J Clin Nutr 2022; 115:595-597. [PMID: 35139162 PMCID: PMC8990105 DOI: 10.1093/ajcn/nqab385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Louis J Aronne
- Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY, USA
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Rafael de Cabo
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Lewis C Cantley
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mark I Friedman
- Monell Chemical Senses Center, Philadelphia, PA, USA,Nutrition Science Initiative, San Diego, CA, USA
| | - Steven B Heymsfield
- Metabolism & Body Composition Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - James D Johnson
- Diabetes Research Group, Life Sciences Institute, University of British Columbia, Vancouver, Canada,Institute for Personalized Therapeutic Nutrition, Vancouver, Canada
| | - Janet C King
- Department of Nutritional Sciences & Toxicology, University of California Berkeley, Berkeley, CA, USA
| | - Ronald M Krauss
- Departments of Pediatrics and Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Gary Taubes
- Nutrition Science Initiative, San Diego, CA, USA
| | - Jeff S Volek
- Department of Human Sciences, Ohio State University, Columbus, OH, USA
| | - Eric C Westman
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Cara B Ebbeling
- From the New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, MA, USA,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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13
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Kumar NK, Merrill JD, Carlson S, German J, Yancy WS. Adherence to Low-Carbohydrate Diets in Patients with Diabetes: A Narrative Review. Diabetes Metab Syndr Obes 2022; 15:477-498. [PMID: 35210797 PMCID: PMC8863186 DOI: 10.2147/dmso.s292742] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/12/2022] [Indexed: 12/13/2022] Open
Abstract
Evidence suggests that low carbohydrate (<130 g/day of carbohydrate) (LCD) and very low carbohydrate, ketogenic diets (typically <50 g/day of carbohydrate) (VLCKD) can be effective tools for managing diabetes given their beneficial effects on weight loss and glycemic control. VLCKD also result in favorable lipid profile changes. However, these beneficial effects can be limited by poor dietary adherence. Cultural, religious, and economic barriers pose unique challenges to achieving nutritional compliance with LCD and VLCKD. We review the various methods for assessing adherence in clinical studies and obstacles posed, as well as potential solutions to these challenges.
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Affiliation(s)
- Nitya Kalyani Kumar
- Division of Endocrinology, Diabetes, & Metabolism, Duke University, Durham, NC, USA
- Correspondence: Nitya Kalyani Kumar, 30 Duke Medicine Circle Clinic 1A, Durham, NC, 27710, USA, Email
| | - Jennifer D Merrill
- Division of Endocrinology, Diabetes, & Metabolism, Ohio State University, Columbus, OH, USA
| | - Scott Carlson
- Division of Endocrinology, Diabetes, & Metabolism, Duke University, Durham, NC, USA
| | - Jashalynn German
- Division of Endocrinology, Diabetes, & Metabolism, Duke University, Durham, NC, USA
| | - William S Yancy
- Duke Lifestyle and Weight Management Center and Division of General Medicine, Duke University, Durham, NC, USA
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14
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Alexopoulos AS, Yancy WS, Edelman D, Coffman CJ, Jeffreys AS, Maciejewski ML, Voils CI, Sagalla N, Barton Bradley A, Dar M, Mayer SB, Crowley MJ. Clinical associations of an updated medication effect score for measuring diabetes treatment intensity. Chronic Illn 2021; 17:451-462. [PMID: 31653175 PMCID: PMC7182482 DOI: 10.1177/1742395319884096] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The medication effect score reflects overall intensity of a diabetes regimen by consolidating dosage and potency of agents used. Little is understood regarding how medication intensity relates to clinical factors. We updated the medication effect score to account for newer agents and explored associations between medication effect score and patient-level clinical factors. METHODS Cross-sectional analysis of baseline data from a randomized controlled trial involving 263 Veterans with type 2 diabetes and hemoglobin A1c levels ≥8.0% (≥7.5% if under age 50). Medication effect score was calculated for all patients at baseline, alongside additional measures including demographics, comorbid illnesses, hemoglobin A1c, and self-reported psychosocial factors. We used multivariable regression to explore associations between baseline medication effect score and patient-level clinical factors. RESULTS Our sample had a mean age of 60.7 (SD = 8.2) years, was 89.4% male, and 57.4% non-White. Older age and younger onset of diabetes were associated with a higher medication effect score, as was higher body mass index. Higher medication effect score was significantly associated with medication nonadherence, although not with hemoglobin A1c, self-reported hypoglycemia, diabetes-related distress, or depression. DISCUSSION We observed several expected associations between an updated medication effect score and patient-level clinical factors. These associations support the medication effect score as an appropriate measure of diabetes regimen intensity in clinical and research contexts.
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Affiliation(s)
- Anastasia-Stefania Alexopoulos
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
| | - William S Yancy
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Diet and Fitness Center, Durham, NC, USA
| | - David Edelman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Amy S Jeffreys
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Nicole Sagalla
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
| | - Anna Barton Bradley
- Richmond Diabetes and Endocrinology, Bon Secours Medical Group, Richmond, VA, USA
| | - Moahad Dar
- Division of Endocrinology and Metabolism, East Carolina University, Greenville NC, USA.,Greenville Veterans Affairs Health Care Center, Greenville, NC, USA
| | - Stéphanie B Mayer
- Hunter Holmes McGuire Veterans Affairs Medical Center, Division of Endocrinology and Metabolism, Richmond, VA, USA.,Virginia Commonwealth University, Division of Endocrinology and Metabolism, Richmond, VA, USA
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA.,Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, USA
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15
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Ludwig DS, Aronne LJ, Astrup A, de Cabo R, Cantley LC, Friedman MI, Heymsfield SB, Johnson JD, King JC, Krauss RM, Lieberman DE, Taubes G, Volek JS, Westman EC, Willett WC, Yancy WS, Ebbeling CB. The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. Am J Clin Nutr 2021; 114:1873-1885. [PMID: 34515299 PMCID: PMC8634575 DOI: 10.1093/ajcn/nqab270] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/26/2021] [Indexed: 12/29/2022] Open
Abstract
According to a commonly held view, the obesity pandemic is caused by overconsumption of modern, highly palatable, energy-dense processed foods, exacerbated by a sedentary lifestyle. However, obesity rates remain at historic highs, despite a persistent focus on eating less and moving more, as guided by the energy balance model (EBM). This public health failure may arise from a fundamental limitation of the EBM itself. Conceptualizing obesity as a disorder of energy balance restates a principle of physics without considering the biological mechanisms that promote weight gain. An alternative paradigm, the carbohydrate-insulin model (CIM), proposes a reversal of causal direction. According to the CIM, increasing fat deposition in the body-resulting from the hormonal responses to a high-glycemic-load diet-drives positive energy balance. The CIM provides a conceptual framework with testable hypotheses for how various modifiable factors influence energy balance and fat storage. Rigorous research is needed to compare the validity of these 2 models, which have substantially different implications for obesity management, and to generate new models that best encompass the evidence.
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Affiliation(s)
- David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Louis J Aronne
- Comprehensive Weight Control Center, Weill Cornell Medicine, New York, NY, USA
| | - Arne Astrup
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Rafael de Cabo
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, USA
| | - Lewis C Cantley
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mark I Friedman
- Monell Chemical Senses Center, Philadelphia, PA, USA
- Nutrition Science Initiative, San Diego, CA, USA
| | - Steven B Heymsfield
- Metabolism & Body Composition Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - James D Johnson
- Diabetes Research Group, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Personalized Therapeutic Nutrition, Vancouver, British Columbia, Canada
| | - Janet C King
- Department of Nutritional Sciences & Toxicology, University of California Berkeley, Berkeley, CA, USA
| | - Ronald M Krauss
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Gary Taubes
- Nutrition Science Initiative, San Diego, CA, USA
| | - Jeff S Volek
- Department of Human Sciences, Ohio State University, Columbus, OH, USA
| | - Eric C Westman
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Walter C Willett
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - William S Yancy
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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16
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Kobe EA, Crowley MJ, Jeffreys AS, Yancy WS, Zervakis J, Edelman D, Voils CI, Maciejewski ML, Coffman CJ. Heterogeneity of Treatment Effects Among Patients With Type 2 Diabetes and Elevated Body Mass Index in a Study Comparing Group Medical Visits Focused on Weight Management and Medication Intensification. Med Care 2021; 59:1031-1038. [PMID: 34510104 PMCID: PMC8516740 DOI: 10.1097/mlr.0000000000001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Illuminating heterogeneity of treatment effect (HTE) within trials is important for identifying target populations for implementation. OBJECTIVE The aim of this study was to examine HTE in a trial of group medical visits (GMVs) for patients with type 2 diabetes and elevated body mass index. RESEARCH DESIGN AND MEASURES Participants (n=263) were randomized to GMV-based medication management plus low carbohydrate diet-focused weight management (WM/GMV; n=127) or GMV-based medication management alone (GMV; n=136) for diabetes control. We used QUalitative INteraction Trees, a tree-based clustering method, to identify subgroups with greater improvement in hemoglobin A1c (HbA1c) and weight from either WM/GMV or GMV. Subgroup predictors included 32 baseline demographic, clinical, and psychosocial factors. Internal validation was conducted to estimate bias in the range of mean outcome differences between arms. RESULTS QUalitative INteraction Trees analyses indicated that for patients who had not previously attempted weight loss, WM/GMV resulted in better glycemic control than GMV (mean difference in HbA1c improvement=1.48%). For patients who had previously attempted weight loss and had lower cholesterol and blood urea nitrogen, GMV was better than WM/GMV (mean difference in HbA1c improvement=1.51%). No treatment-subgroup effects were identified for weight. Internal validation resulted in moderate corrections in mean HbA1c differences between arms; however, differences remained in the clinically significant range. CONCLUSION This work represents a novel step toward targeting care approaches for patients to maximize benefit based on individual patient characteristics.
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Affiliation(s)
| | - Matthew J. Crowley
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Change (ADAPT), Durham, NC
- Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Amy S. Jeffreys
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Change (ADAPT), Durham, NC
| | - William S. Yancy
- Duke University School of Medicine, Durham, NC
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Change (ADAPT), Durham, NC
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC
- Duke Lifestyle and Weight Management Center, Durham, NC
| | - Jennifer Zervakis
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Change (ADAPT), Durham, NC
| | - David Edelman
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Change (ADAPT), Durham, NC
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Corrine I. Voils
- William S Middleton Memorial Veterans Hospital, Madison, WI
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Matthew L. Maciejewski
- Duke University School of Medicine, Durham, NC
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Change (ADAPT), Durham, NC
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Cynthia J. Coffman
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Change (ADAPT), Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
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17
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Voils CI, Pendergast J, Hale SL, Gierisch JM, Strawbridge EM, Levine E, McVay MA, Reed SD, Yancy WS, Shaw RJ. A randomized feasibility pilot trial of a financial incentives intervention for dietary self-monitoring and weight loss in adults with obesity. Transl Behav Med 2021; 11:954-969. [PMID: 33245118 DOI: 10.1093/tbm/ibaa102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Financial incentives could be used to improve adherence to behavioral weight loss interventions, increasing their effectiveness. This Phase IIb randomized pilot study evaluated the feasibility and acceptability of a study protocol for providing financial incentives for dietary self-monitoring and/or weight loss. Community-dwelling adults with obesity were enrolled in a 24 week, group-based weight loss program. Participants were randomized in a 2 × 2 factorial design to receive financial incentives for both dietary self-monitoring and weekly weight loss, just one, or neither. Participants could earn up to $300, evolving from fixed weekly payments to intermittent, variable payments. The notice of reward was provided by text message. The study was conducted in three successive cohorts to evaluate study procedure changes, including dietary approach, recruitment and retention strategies, text messaging, and incentives. Descriptive statistics calculated separately for each cohort described study performance relative to predefined targets for recruitment, including minority representation; retention; adherence; and weight loss. Acceptability was assessed via postintervention qualitative interviews. In Cohort 1 (n = 34), a low-carbohydrate diet was used. Recruitment, retention, adherence, and weight loss were adequate, but minority representation was not. For Cohort 2 (n = 31), employing an additional recruitment method and switching to a reduced-calorie diet yielded adequate recruitment, minority representation, retention, and adherence but less weight loss. Returning to a low-carbohydrate diet in Cohort 3 (n = 28) yielded recruitment, minority representation, retention, adherence, and weight loss similar to Cohort 2. Participant feedback informed changes to text message timing and content and incentive amount. Through successive cohorts, we optimized recruitment and retention strategies and text messaging. An adequately powered trial is warranted to evaluate the efficacy of these incentive structures for reducing weight. The trial registration number is NCT02691260.
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Affiliation(s)
- Corrine I Voils
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Research Service, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | | | - Sarah L Hale
- School of Medicine, Duke University, Durham, NC, USA
| | - Jennifer M Gierisch
- School of Medicine, Duke University, Durham, NC, USA.,Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | | | - Megan A McVay
- College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Shelby D Reed
- School of Medicine, Duke University, Durham, NC, USA
| | - William S Yancy
- School of Medicine, Duke University, Durham, NC, USA.,Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Ryan J Shaw
- School of Nursing, Duke University, Durham, NC, USA
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18
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Abstract
Roy Taylor and colleagues explain how type 2 diabetes can be reversed by weight loss and avoidance of weight regain
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Affiliation(s)
- Roy Taylor
- Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Chennai, India
- Dr A Ramachandran's Diabetes Hospitals, Chennai, India
| | - William S Yancy
- Duke Lifestyle and Weight Management Center, Duke University Health System and Department of Medicine, Duke University Medical School, Durham, NC, USA
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
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19
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Rosenberg J, Hyde PN, Yancy WS, Ford KM, Champ CE. Quantity of Resistance Exercise for Breast Cancer Patients: Does the Dose Match the Objective? J Strength Cond Res 2021; 35:1467-1476. [PMID: 33900267 DOI: 10.1519/jsc.0000000000003996] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Rosenberg, J, Hyde, PN, Yancy, WS, Ford, KM, and Champ, CE. Quantity of resistance exercise for breast cancer patients: does the dose match the objective? J Strength Cond Res 35(5): 1467-1476, 2021-There is currently a lack of consensus as to what defines exercise and resistance training in the cancer setting and whether current studies comply with exercise guidelines. This study aimed to quantify the available research studies using resistance training exercise interventions in the breast cancer setting for future clinical trial utilization. We systemically reviewed all available resistance exercise studies during and after breast cancer treatment in an attempt to quantify to the prescribed dose and whether regimens aligned with general exercise guidelines to improve functional mobility, body composition, and metabolic function. They were then compared with recommendations set forth by the national committees that create evidence-based exercise guidelines. Fifty studies met the initial criteria, with 35 meeting analysis criteria for evaluation. Fifteen studies evaluated an exercise regimen during cancer treatment, and 20 evaluated a regimen after treatment. The average adherence rates were 84% for all studies. Only 23 studies listed specific exercises used within the protocol. Most exercise regimens relied on open chain movements and machine exercises. Around half of studies met criteria to achieve hypertrophy, and 66% met American College of Sports Medicine exercise guidelines for cancer patients. A minority of breast cancer studies implementing a resistance training exercise regimen prescribed a regimen or specific dose that follows general exercise guidelines. This study highlights a potential deficiency in exercise programs designed for patients with breast cancer, and these findings should be considered in future study design.
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Affiliation(s)
- Jared Rosenberg
- Duke Diet and Fitness Center, Durham, North Carolina
- Department of Exercise Science, Syracuse University, Syracuse, New York
| | - Parker N Hyde
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
- Department of Kinesiology, University of North Georgia, Dahlonega, Georgia
| | | | - Kenneth M Ford
- Institute for Human and Machine Cognition, Pensacola, Florida; and
| | - Colin E Champ
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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20
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Gavin KL, Voils CI, Yancy WS, Olsen MK. Two-year weight trajectories following completion of a behavioral weight loss maintenance intervention. Obes Sci Pract 2021; 7:321-325. [PMID: 34123398 PMCID: PMC8170567 DOI: 10.1002/osp4.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/08/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Long‐term effects of behavioral weight loss maintenance interventions need to be assessed in order to understand their durability of effects. This can be evaluated with the use of weights recorded in the electronic medical record. The goal of this study was to use electronic health record (EHR)‐recorded weight to examine outcomes 2 years beyond the completion of a trial in which participants were randomized to receive a weight maintenance intervention or usual care after required initial weight loss. Methods Weights collected in the Veteran's Affairs national EHR were obtained for 2 years following trial completion. Outliers and implausible weights were identified and removed prior to analysis. Mixed‐effects models with quadratic time were fit to estimate between‐arm differences in weight change. Results Model‐estimated weight at trial completion was 109.7 kg for usual care and 106.8 kg for intervention, estimated difference of −2.9 kg (95% confidence interval [CI]: −8.8, 3.0; p = 0.34). Two years later, estimated mean weight collected from (n = 211) participants with available EMR weights was 111.5 kg for usual care and 108.0 kg for intervention, estimated difference −3.4 kg (95% CI: −9.3, 2.4 kg; p = 0.35). Conclusions While not statistically significant, weights from the EHR suggest the possibility of a clinically meaningful difference that should be confirmed by future adequately powered studies.
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Affiliation(s)
- Kara L Gavin
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA.,Research Service William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
| | - Corrine I Voils
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA.,Research Service William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
| | - William S Yancy
- Department of Medicine Duke University School of Medicine Durham North Carolina USA.,Center for Health Services Research in Primary Care Durham VA Health Care System Durham North Carolina USA
| | - Maren K Olsen
- Center for Health Services Research in Primary Care Durham VA Health Care System Durham North Carolina USA.,Department of Biostatistics and Bioinformatics Duke University School of Medicine Durham North Carolina USA
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21
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McVay MA, Yancy WS, Bennett GG, Levine E, Jung SH, Jung S, Anton S, Voils CI. A web-based intervention to increase weight loss treatment initiation: results of a cluster randomized feasibility and acceptability trial. Transl Behav Med 2021; 11:226-235. [PMID: 31586443 PMCID: PMC7877306 DOI: 10.1093/tbm/ibz143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Evidence-based behavioral weight loss treatment is under-utilized. To increase initiation of treatment, we developed a single-session, online, primary care-based intervention ("mobilization tool"). We evaluated the mobilization tool's acceptability for primary care patients with obesity, trial design feasibility, and signal of an effect of the tool on treatment initiation. In this cluster randomized feasibility trial, primary care providers (PCPs) were randomized to a mobilization tool or comparator tool arm. Patients with obesity and a scheduled appointment with a randomized PCP were assigned to complete the mobilization or comparator tool prior to their appointment. The online mobilization tool asks patients to answer questions about a variety of weight-related topics and then provides automated, tailored feedback that addresses psychosocial determinants of weight loss treatment initiation. The comparator tool provided a nontailored description of treatments. All participants were offered free enrollment in behavioral weight loss treatments. Six PCPs were randomized. Sixty patients (57% female; 66% white; aged 55 ± 13 years) participated in this study of 296 contacted for eligibility evaluation (20.2%). Six-month follow-up assessments were completed by 65% (22/34) of the mobilization and 73% (19/26) of comparator tool participants. Participants completing the acceptability survey reported that the mobilization tool was usable, enjoyable, informative, and useful. Weight loss treatment was initiated by 59% (n = 19) of mobilization and 33% (n = 8) of comparator tool participants. The mobilization tool shows promise for increasing treatment initiation among primary care patients, which may increase population weight loss. Trial Registration: Clinicaltrials.gov identifier: NCT02708121.
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Affiliation(s)
- Megan A McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
- Department of Psychiatry and Behavioral Science, Duke University, Durham, NC, USA
| | - William S Yancy
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Department of Veteran Affairs, Durham, NC, USA
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Erica Levine
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Seung-Hye Jung
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
| | - Soyeon Jung
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Steve Anton
- Center for Aging, University of Florida, Gainesville, FL, USA
| | - Corrine I Voils
- William S Middleton VA, Department of Veterans Affairs, Madison, WI, USA
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Abstract
PURPOSE OF REVIEW This study will provide a narrative review of the history of the clinical use of low-carbohydrate diets and give a practical example of how to implement a low-carbohydrate diet, with an emphasis on deprescribing medications. RECENT FINDINGS Low-carbohydrate diets have been used since the late 19th century to treat obesity and type 2 diabetes mellitus (T2DM). Recently, clinical research has validated the use of low-carbohydrate diets for individuals affected by obesity and T2DM, and these diets are included in several national clinical guidelines. Because medications are commonly used to treat hypertension and T2DM, special consideration must be made to monitor and reduce these medications to avoid overmedication. Clinic visits and home monitoring of blood pressure and glucose levels are important tools to alert clinicians that a reduction in medication levels may be indicated. SUMMARY Low-carbohydrate diets have been utilized clinically for many years to treat obesity and T2DM and can be used alongside effective monitoring to safely deprescribe dispensable medications for these diseases.
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Affiliation(s)
- Eric C Westman
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center
| | - William S Yancy
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center
- Duke Diet and Fitness Center, Duke University Health System, Durham, North Carolina, USA
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23
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Voils CI, Shaw R, Adler R, Jeanes E, Lewis MA, Sharp W, Cronin KA, Hetzel S, Mao L, Johnson HM, Elwert F, Pabich S, Gavin KL, Yancy WS, Porter LS. Protocol for Partner2Lose: A randomized controlled trial to evaluate partner involvement on long-term weight loss. Contemp Clin Trials 2020; 96:106092. [PMID: 32750431 PMCID: PMC7395658 DOI: 10.1016/j.cct.2020.106092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 11/25/2022]
Abstract
Background Behavioral interventions produce clinically significant weight reduction, with many participants regaining weight subsequently. Most interventions focus on an individual, but dietary and physical activity behaviors occur with, or are influenced by, domestic partners. According to interdependence theory, couples who approach behavior change as a problem to be tackled together versus independently are more likely to utilize communal coping processes to promote behavior change. We utilized interdependence theory to develop a partner-assisted intervention to increase long-term weight loss. Methods Community-dwelling individuals (index participants) cohabitating with a partner with 1) overweight and at least one obesity-related comorbidity or 2) obesity are randomized to participate in a standard weight management program alone or with their partner. The weight management program involves biweekly, in-person, group sessions focusing on weight loss for six months, followed by three group sessions and nine telephone calls focusing on weight loss maintenance for twelve months. In the partner-assisted arm, partners participate in half of the group sessions and telephone calls. Couples receive training in principles of cognitive behavioral therapy for couples, including sharing thoughts and feelings and joint problem solving, to increase communal coping. The primary outcome is participant weight loss at 24 months, with caloric intake and moderate-intensity physical activity as secondary outcomes. Partner weight and caloric intake will also be analyzed. Mediation analyses will examine the role of interdependence variables and social support. Discussion This trial will provide knowledge about effective ways to promote long-term weight loss and the role of interdependence constructs in weight loss. Clinical trials identifier: NCT 03801174.
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Affiliation(s)
- Corrine I Voils
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI 53792-1690, USA; William S Middleton Memorial Veterans Hospital, 2500 Overlook Terrace (151), Madison, WI 53705, USA.
| | - Ryan Shaw
- Duke University School of Nursing, 307 Trent Dr., 1055 Clipp, Durham, NC 27710, USA
| | - Rachel Adler
- Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street Suite 2-016, Boston, MA 02120, USA
| | - Elizabeth Jeanes
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI 53792-1690, USA
| | - Megan A Lewis
- RTI International, 119 S. Main St., Union Trust Bldg., Suite 220, Seattle, WA 98104, USA
| | - Whitney Sharp
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI 53792-1690, USA
| | - Kate A Cronin
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI 53792-1690, USA
| | - Scott Hetzel
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Biostatistics and Bioinformatics, 610 Walnut St, WARF 201, Madison, WI 53726, USA
| | - Lu Mao
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Biostatistics and Bioinformatics, 610 Walnut St, WARF 201, Madison, WI 53726, USA
| | - Heather M Johnson
- Boca Raton Regional Hospital, Christine E. Lynn Women's Health & Wellness Institute, 690 Meadows Road, Boca Raton, FL 33486, USA
| | - Felix Elwert
- University of Wisconsin-Madison Department of Sociology, 11800 Observatory Dr, Madison, WI 53706, USA
| | - Samantha Pabich
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Medicine, 1685 Highland Ave Madison, WI 53705-2281, USA
| | - Kara L Gavin
- University of Wisconsin-Madison School of Medicine & Public Health, Department of Surgery, 600 Highland Ave, K6/100 CSC, Madison, WI 53792-1690, USA
| | - William S Yancy
- Duke University School of Medicine, Department of Medicine, 501 Douglas St., Durham, NC 27705, USA
| | - Laura S Porter
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Box 90399, Durham, NC 27708, USA
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Abstract
Low-carbohydrate diets have been advocated as an effective method for promoting weight loss in overweight and obese individuals and preventing and treating type 2 diabetes. This article reviews the differences between various low-carbohydrate eating plans and discusses the benefits and drawbacks of such a diet based on available evidence. It also offers practical pointers for clinicians.
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Affiliation(s)
- Jennifer D. Merrill
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - Diana Soliman
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - Nitya Kumar
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - Sooyoung Lim
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Afreen I. Shariff
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - William S. Yancy
- Duke Diet and Fitness Center, Department of Medicine, Duke University Health System, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC
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25
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Affiliation(s)
- Colin E Champ
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - William S Yancy
- Duke Diet and Fitness Center, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize our current knowledge of factors that influence clinical decision making and management of type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) among South Asians (SA). RECENT FINDINGS ASCVD and T2DM in SAs have been examined in recent times. Pathophysiologic and genetic factors including the role of adiponectin, visceral adiposity, lower beta cell function, and psycho-social factors like sedentary lifestyle, poor adherence to medications, and carbohydrate dense meals play a role in early development and the high-risk presentation of both ASCVD and T2DM in SA. Recently, large population-based cohort studies have attempted to compare outcomes and interventions that can be translated to timely detection and targeted interventions in this high-risk group. SAs in the USA are more likely to be diagnosed with T2DM and ASCVD when compared to non-Hispanic whites, non-Hispanic Blacks, and Hispanic populations. The development of personalized ethnic risk assessment tools and better representation of SAs in prospective studies are essential to increasing our understanding and management of cardio-metabolic disease in SA living in the USA.
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Affiliation(s)
- Afreen I Shariff
- Division of Endocrinology, Metabolism and Nutrition, Duke University School of Medicine, Durham, NC, USA.
- DUMC, 3021, Durham, NC, 27710, USA.
| | - Nitya Kumar
- Division of Endocrinology, Metabolism and Nutrition, Duke University School of Medicine, Durham, NC, USA
| | - William S Yancy
- Duke Diet and Fitness Center, Duke University Health System, Durham, NC, USA
- Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Leonor Corsino
- Division of Endocrinology, Metabolism and Nutrition, Duke University School of Medicine, Durham, NC, USA
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27
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Yancy WS, Crowley MJ, Dar MS, Coffman CJ, Jeffreys AS, Maciejewski ML, Voils CI, Bradley AB, Edelman D. Comparison of Group Medical Visits Combined With Intensive Weight Management vs Group Medical Visits Alone for Glycemia in Patients With Type 2 Diabetes: A Noninferiority Randomized Clinical Trial. JAMA Intern Med 2020; 180:70-79. [PMID: 31682682 PMCID: PMC6830502 DOI: 10.1001/jamainternmed.2019.4802] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Traditionally, group medical visits (GMVs) for persons with diabetes improved glycemia by intensifying medications, which infrequently led to weight loss. Incorporating GMVs with intensive dietary change could enable weight loss and improve glycemia while decreasing medication intensity. OBJECTIVE To examine whether a program of GMVs combined with intensive weight management (WM) is noninferior to GMVs alone for change in glycated hemoglobin (HbA1c) level at 48 weeks (prespecified margin of 0.5%) and superior to GMVs alone for hypoglycemic events, diabetes medication intensity, and weight loss. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial identified via the electronic medical record 2814 outpatients with type 2 diabetes, uncontrolled HbA1c, and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 27 or higher from Veterans Affairs Medical Center clinics in Durham and Greenville, North Carolina. Between January 12, 2015, and May 30, 2017, 263 outpatients started the intervention. INTERVENTIONS Participants randomized to the GMV group (n = 136) received counseling about diabetes-related topics with medication optimization every 4 weeks for 16 weeks, then every 8 weeks (9 visits). Participants randomized to the WM/GMV group (n = 127) received low-carbohydrate diet counseling with baseline medication reduction and subsequent medication optimization every 2 weeks for 16 weeks followed by an abbreviated GMV intervention every 8 weeks (13 visits). MAIN OUTCOMES AND MEASURES Outcomes included HbA1c level, hypoglycemic events, diabetes medication effect score, and weight at 48 weeks analyzed using hierarchical generalized mixed models to account for clustering within group sessions. RESULTS Among 263 participants (mean [SD] age, 60.7 [8.2] years; 235 [89.4%] men; 143 [54.4%] black), baseline HbA1c level was 9.1% (1.3%) and BMI was 35.3 (5.1). At 48 weeks, HbA1c level was improved in both study arms (8.2% in the WM/GMV arm and 8.3% in the GMV arm; mean difference, -0.1%; 95% CI, -0.5% to 0.2%; upper 95% CI, <0.5% threshold; P = .44). The WM/GMV arm had lower diabetes medication use (mean difference in medication effect score, -0.5; 95% CI, -0.6 to -0.3; P < .001) and greater weight loss (mean difference, -3.7 kg; 95% CI, -5.5 to -1.9 kg; P < .001) than did the GMV arm at 48 weeks and approximately 50% fewer hypoglycemic events (incidence rate ratio, 0.49; 95% CI, 0.27 to 0.71; P < .001) during the 48-week period. CONCLUSIONS AND RELEVANCE In GMVs for diabetes, addition of WM using a low-carbohydrate diet was noninferior for lowering HbA1c levels compared with conventional medication management and showed advantages in other clinically important outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01973972.
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Affiliation(s)
- William S Yancy
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Diet and Fitness Center, Durham, North Carolina
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina.,Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Moahad S Dar
- Greenville Health Care Center, Department of Veterans Affairs, Greenville, North Carolina.,Brody School of Medicine, Greenville, North Carolina
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Amy S Jeffreys
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina.,Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Surgery, University of Wisconsin, Madison
| | | | - David Edelman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Smith VA, Arterburn DE, Berkowitz TSZ, Olsen MK, Livingston EH, Yancy WS, Weidenbacher HJ, Maciejewski ML. Association Between Bariatric Surgery and Long-term Health Care Expenditures Among Veterans With Severe Obesity. JAMA Surg 2019; 154:e193732. [PMID: 31664427 DOI: 10.1001/jamasurg.2019.3732] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Bariatric surgery has been associated with improvements in health in patients with severe obesity; however, it is unclear whether these health benefits translate into lower health care expenditures. Objective To examine 10-year health care expenditures in a large, multisite retrospective cohort study of veterans with severe obesity who did and did not undergo bariatric surgery. Design, Setting, and Participants A total of 9954 veterans with severe obesity between January 1, 2000, and September 30, 2011, were identified from veterans affairs (VA) electronic health records. Of those, 2498 veterans who underwent bariatric surgery were allocated to the surgery cohort. Sequential stratification was used to match each patient in the surgery cohort with up to 3 patients who had not undergone bariatric surgery but were of the same sex, race/ethnicity, diabetes status, and VA regional network and were closest in age, body mass index (calculated as weight in kilograms divided by height in meters squared), and comorbidities. A total of 7456 patients were identified and allocated to the nonsurgery (control) cohort. The VA health care expenditures among the surgery and nonsurgery cohorts were estimated using regression models. Data were analyzed from July to August 2018 and in April 2019. Interventions The bariatric surgical procedures (n = 2498) included in this study were Roux-en-Y gastric bypass (1842 [73.7%]), sleeve gastrectomy (381 [15.3%]), adjustable gastric banding (249 [10.0%]), and other procedures (26 [1.0%]). Main Outcomes and Measures The study measured total, outpatient, inpatient, and outpatient pharmacy expenditures from 3 years before surgery to 10 years after surgery, excluding expenditures associated with the initial bariatric surgical procedure. Results Among 9954 veterans with severe obesity, 7387 (74.2%) were men; the mean (SD) age was 52.3 (8.8) years for the surgery cohort and 52.5 (8.7) years for the nonsurgery cohort. Mean total expenditures for the surgery cohort were $5093 (95% CI, $4811-$5391) at 7 to 12 months before surgery, which increased to $7448 (95% CI, $6989-$7936) at 6 months after surgery. Postsurgical expenditures decreased to $6692 (95% CI, $6197-$7226) at 5 years after surgery, followed by a gradual increase to $8495 (95% CI, $7609-$9484) at 10 years after surgery. Total expenditures were higher in the surgery cohort than in the nonsurgery cohort during the 3 years before surgery and in the first 2 years after surgery. The expenditures of the 2 cohorts converged 5 to 10 years after surgery. Outpatient pharmacy expenditures were significantly lower among the surgery cohort in all years of follow-up ($509 lower at 3 years before surgery and $461 lower at 7 to 12 months before surgery), but these cost reductions were offset by higher inpatient and outpatient (nonpharmacy) expenditures. Conclusions and Relevance In this cohort study of 9954 predominantly older male veterans with severe obesity, total health care expenditures increased immediately after patients underwent bariatric surgery but converged with those of patients who had not undergone surgery at 10 years after surgery. This finding suggests that the value of bariatric surgery lies primarily in its associations with improvements in health and not in its potential to decrease health care costs.
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Affiliation(s)
- Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle.,Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle
| | - Theodore S Z Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Maren K Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Edward H Livingston
- Department of Surgery, University of California, Los Angeles, Los Angeles.,Division of General Surgery, Northwestern University, Chicago, Illinois.,Deputy Editor
| | - William S Yancy
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Hollis J Weidenbacher
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
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29
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Affiliation(s)
- William S Yancy
- Duke Diet and Fitness Center, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina
| | - Nia S Mitchell
- Duke Diet and Fitness Center, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Eric C Westman
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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30
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Yancy WS, Shaw PA, Reale C, Hilbert V, Yan J, Zhu J, Troxel AB, Foster GD, Volpp KG. Effect of Escalating Financial Incentive Rewards on Maintenance of Weight Loss: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1914393. [PMID: 31675083 PMCID: PMC6826643 DOI: 10.1001/jamanetworkopen.2019.14393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Identifying effective strategies for treating obesity is a public health priority. OBJECTIVE To test an escalating lottery-based incentive tied to daily self-weighing for weight loss maintenance. DESIGN, SETTING, AND PARTICIPANTS This 2-phase, 2-arm randomized clinical trial enrolled participants aged 30 to 80 years with an initial body mass index (calculated as weight in kilograms divided by height in meters squared) of 30.0 to 45.0 who lost at least 5 kg during 4 to 6 months in a national online weight management program. Study investigators and outcomes assessors were blinded to participant groups. Data were collected and analyzed from May 23, 2016, through November 13, 2017, based on intention to treat. INTERVENTIONS All participants were advised to weigh themselves daily, with a goal of 6 or more days per week, and received text messaging feedback on their performance. Incentive group participants were eligible for a lottery-based incentive worth an expected value of $3.98 in week 1 that escalated by $0.43 each week they achieved their self-weighing goal during months 1 to 6 (phase 1), followed by no incentives during months 7 to 12 (phase 2). MAIN OUTCOMES AND MEASURES The primary outcome was weight change at the end of phase 1. Secondary outcomes included weight change at the end of phase 2 and changes in self-reported physical activity and eating behaviors. RESULTS A total of 258 participants (128 in the incentive group and 130 in the control group) had a mean (SD) age of 48.0 (10.5) years and mean (SD) body mass index of 32.1 (3.9); 225 (87.2%) were women; 235 (91.1%) were white; and 102 (39.5%) had an annual income of at least $100 000. Weight measurement was transmitted by 250 participants (96.9%) at 6 months and 227 (88.0%) at 12 months. The percentage of weeks that incentive and control participants achieved a mean self-weighing of at least 6 times was 85.3% vs 75.8%, respectively (P = .002) in phase 1 and 37.7% vs 50.2%, respectively (P = .009) in phase 2. Mean weight changes at the end of phase 1 were -1.1 (95% CI, -2.1 to -0.1) kg in the incentive group and -1.9 (95% CI, -2.9 to -0.8) kg in the control group, with a mean difference of 0.7 (95% CI, -0.7 to 2.2) kg (P = .30 for comparison). At the end of phase 2, mean weight changes were 0.2 (95% CI, -1.2 to 1.7) kg in the incentive group and -0.6 (95% CI, -2.0 to 0.8) kg in the control group, with a mean difference of 0.8 (95% CI, -1.2 to 2.8) kg (P = .41 for comparison). CONCLUSIONS AND RELEVANCE Compared with an active control condition of weekly messages, escalating lottery-based incentives transiently increased rates of self-weighing but did not significantly enhance weight loss maintenance. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01900392.
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Affiliation(s)
- William S Yancy
- Duke University Diet and Fitness Center, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina
| | - Pamela A Shaw
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Catherine Reale
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Victoria Hilbert
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jiali Yan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jingsan Zhu
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Andrea B Troxel
- Department of Population Health, New York University School of Medicine, New York
| | - Gary D Foster
- Department of Science, WW (formerly Weight Watchers), New York, New York
- Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kevin G Volpp
- Leonard Davis Institute Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, Saslow L, Uelmen S, Urbanski PB, Yancy WS. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care 2019; 42:731-754. [PMID: 31000505 PMCID: PMC7011201 DOI: 10.2337/dci19-0014] [Citation(s) in RCA: 576] [Impact Index Per Article: 115.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Alison B Evert
- UW Neighborhood Clinics, UW Medicine, University of Washington, Seattle, WA
| | | | - Christopher D Gardner
- Stanford Diabetes Research Center and Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
| | - W Timothy Garvey
- Diabetes Research Center, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
- Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | | | | | - Joanna Mitri
- Section on Clinical, Behavioral and Outcomes Research Lipid Clinic, Adult Diabetes Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | | | | | | | - Laura Saslow
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI
| | | | | | - William S Yancy
- Duke Diet and Fitness Center, Department of Medicine, Duke University Health System, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC
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Mitchell NS, Scialla JJ, Yancy WS. Are low-carbohydrate diets safe in diabetic and nondiabetic chronic kidney disease? Ann N Y Acad Sci 2019; 1461:25-36. [PMID: 30644556 DOI: 10.1111/nyas.13997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022]
Abstract
Diabetes mellitus and obesity both contribute to chronic kidney disease (CKD) and diabetic kidney disease (DKD), and they can accelerate the loss of kidney function. Dietary intake can potentially have wide-reaching effects on the risk of CKD/DKD and their progression by reducing weight and blood pressure, improving glycemic control, reducing hyperfiltration, and modulating inflammation. Low-carbohydrate (LC) diets can reduce weight and improve glycemic control, but the relatively higher protein content also raises concern in CKD/DKD. Empiric evidence supporting the kidney-related benefits or risks of LC diets is needed to understand the balance of these potential harms and benefits for patients with DKD and is the subject of our review.
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Affiliation(s)
- Nia S Mitchell
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Diet and Fitness Center, Duke University Health System, Durham, North Carolina
| | - Julia J Scialla
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - William S Yancy
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Diet and Fitness Center, Duke University Health System, Durham, North Carolina.,Department of Veterans Affairs, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
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Funk LM, Grubber JM, McVay MA, Olsen MK, Yancy WS, Voils CI. Patient predictors of weight loss following a behavioral weight management intervention among US Veterans with severe obesity. Eat Weight Disord 2018; 23:587-595. [PMID: 28853051 PMCID: PMC6985907 DOI: 10.1007/s40519-017-0425-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/29/2017] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Identification of patient characteristics that are associated with behavioral weight loss success among bariatric surgery candidates could inform selection of optimal bariatric surgery candidates. We examined the associations between psychosocial characteristics and weight loss in a group of Veterans with severe obesity who participated in a behavioral weight loss intervention. METHODS The MAINTAIN trial involved a 16-week weight loss program followed by randomization among participants losing at least 4 kg to a maintenance intervention or usual care. This secondary analysis was performed on Veterans who participated in the 16-week weight loss program and met NIH criteria for bariatric surgery (body mass index [BMI] 35.0-39.9 with at least 1 obesity-related comorbidity or BMI ≥ 40). Unadjusted and adjusted associations between baseline patient characteristics and weight loss during the 16-week induction phase were evaluated with linear regression. Missing weight measurements were multiply imputed, and results combined across ten imputations. RESULTS Among the 206 patients who met inclusion criteria, mean initial BMI was 40.8 kg/m2 (SD 6.0), and mean age was 59.2 years (SD 9.4). Approximately 20% of participants were female, 51.5% were Black, and 44.7% were White. Estimated mean 16-week weight loss was 5.16 kg (SD 4.31). In adjusted analyses, greater social support and older age were associated with greater weight loss (p < 0.05). None of the nine psychosocial characteristics we examined were associated with greater weight loss. CONCLUSIONS Understanding and strengthening the level of social support for bariatric surgery candidates may be important given that it appears to be strongly correlated with behavioral weight loss success. LEVEL OF EVIDENCE Level II, Evidence obtained from well-designed controlled trials without randomization. TRIAL REGISTRATION ClinicalTrials.gov NCT01357551 http://clinicaltrials.gov/show/NCT01357551 .
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Affiliation(s)
- Luke M Funk
- William S. Middleton VA, Madison, WI, USA. .,Department of Surgery, University of Wisconsin, Madison, WI, USA.
| | - Janet M Grubber
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Megan A McVay
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Maren K Olsen
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - William S Yancy
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Corrine I Voils
- William S. Middleton VA, Madison, WI, USA.,Department of Surgery, University of Wisconsin, Madison, WI, USA
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Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) has reached epidemic proportions in the modern world. For individuals affected by obesity-related T2DM, clinical studies have shown that carbohydrate restriction and weight loss can improve hyperglycemia, obesity, and T2DM. AREAS COVERED Reducing carbohydrate intake to a certain level, typically below 50 g per day, leads to increased ketogenesis in order to provide fuel for the body. Such low-carbohydrate, ketogenic diets were employed to treat obesity and diabetes in the 19th and early 20th centuries. Recent clinical research has reinvigorated the use of the ketogenic diet for individuals with obesity and diabetes. Although characterized by chronic hyperglycemia, the underlying cause of T2DM is hyperinsulinemia and insulin resistance, typically as a result of increased energy intake leading to obesity. The ketogenic diet substantially reduces the glycemic response that results from dietary carbohydrate as well as improves the underlying insulin resistance. This review combines a literature search of the published science and practical guidance based on clinical experience. EXPERT COMMENTARY While the current treatment of T2DM emphasizes drug treatment and a higher carbohydrate diet, the ketogenic diet is an effective alternative that relies less on medication, and may even be a preferable option when medications are not available.
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Affiliation(s)
- Eric C Westman
- a Division of General Internal Medicine, Department of Medicine , Duke University Medical Center , Durham , NC , USA
| | - Justin Tondt
- b Geisinger Commonwealth School of Medicine , Scranton , PA , USA
| | | | - William S Yancy
- a Division of General Internal Medicine, Department of Medicine , Duke University Medical Center , Durham , NC , USA
- d Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center , Durham , NC , USA
- e Duke Diet and Fitness Center , Duke University Health System , Durham , NC , USA
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Taylor SS, Olsen MK, McVay MA, Grubber J, Gierisch JM, Yancy WS, Voils CI. The role of group cohesion in a group-based behavioral weight loss intervention. J Behav Med 2018; 42:162-168. [PMID: 30076501 DOI: 10.1007/s10865-018-9953-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
Behavioral weight loss interventions are often delivered in groups. Group cohesion may enhance program attendance and, thereby, weight loss. In this secondary analysis, our goals were to: (1a) assess whether group cohesion measured early in a behavioral weight loss intervention predicts program attendance and weight loss outcomes and, if so, (1b) explore whether attendance mediates the link between group cohesion and weight loss; (2) characterize the association between change in group cohesion and weight loss throughout the intervention. Veterans (n = 324) initiated a 16-week, group-based behavioral weight loss program involving biweekly in-person group visits. In linear regression models, early group cohesion was unrelated to group attendance or weight loss. Although group cohesion significantly increased during the intervention, this change was not associated with weight loss. These findings are consistent with the limited literature; however, they are inconsistent with theoretical assertions and clinical observations of the influence of group factors on outcomes.
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Affiliation(s)
- Shannon S Taylor
- Department of Behavioral, Social and Population Health Sciences, University of South Carolina School of Medicine, Columbia, USA.,Department of Family Medicine, Greenville Health System, Greenville, USA
| | - Maren K Olsen
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Megan A McVay
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Janet Grubber
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Population and Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - William S Yancy
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA. .,Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, K6/100 CSC, Madison, WI, 53792-1690, USA.
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McVay MA, Yancy WS, Bennett GG, Jung SH, Voils CI. Perceived barriers and facilitators of initiation of behavioral weight loss interventions among adults with obesity: a qualitative study. BMC Public Health 2018; 18:854. [PMID: 29996812 PMCID: PMC6042474 DOI: 10.1186/s12889-018-5795-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/04/2018] [Indexed: 01/25/2023] Open
Abstract
Background Evidence-based behavioral weight loss interventions are under-utilized. To inform efforts to increase uptake of these interventions, it is important to understand the perspectives of adults with obesity regarding barriers and facilitators of weight loss intervention initiation. Methods We conducted a qualitative study in adults with obesity who had recently attempted weight loss either with assistance from an evidence-based behavioral intervention (intervention initiators) or without use of a formal intervention (intervention non-initiators). We recruited primary care patients, members of a commercial weight loss program, and members of a Veterans Affairs weight loss program. Intervention initiators and non-initiators were interviewed separately using a semi-structured interview guide that asked participants about barriers and facilitators of weight loss intervention initiation. Conversations were audio-recorded and transcribed. Data were analyzed with qualitative content analysis. Two researchers used open coding to generate the code book on a subset of transcripts and a single researcher coded remaining transcripts. Codes were combined into subthemes, which were combined in to higher order themes. Intervention initiators and non-initiators were compared. Results We conducted three focus groups with participants who had initiated interventions (n = 26) and three focus groups (n = 24) and 8 individual interviews with participants who had not initiated interventions. Intervention initiators and non-initiators were, respectively, 65% and 37.5% white, 62% and 63% female, mean age of 55 and 54 years old, and mean BMI of 34 kg/m2. Three themes were identified. One theme was practical factors, with subthemes of reasonable cost and scheduling compatibility. A second theme was anticipated effectiveness of intervention, with subthemes of intervention content addressing individual needs; social aspects influencing effectiveness; and evaluating evidence of effectiveness. A third theme was anticipated pleasantness of intervention, with subthemes of social aspects influencing enjoyment; anticipated dietary and tracking prescriptions; and identity and self-reliance factors. Different perspectives were identified from intervention initiators and non-initiators. Conclusions Strategies to engage individuals in evidence-based weight loss interventions can be developed using these results. Strategies could target individuals’ perceived barriers and benefits to initiating interventions, or could focus on refining interventions to appeal to more individuals. Electronic supplementary material The online version of this article (10.1186/s12889-018-5795-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA.
| | - William S Yancy
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 501 Douglas Street, Duke Diet & Fitness Center, Durham, NC, USA
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Box 90086, Durham, NC, 27708, USA.,Duke Global Health Institute, Duke University, 310 Trent St, Durham, NC, 27710, USA
| | - Seung-Hye Jung
- Duke Office of Clinical Research, Duke University Medical Center, 2424 Erwin Rd, Durham, NC, 27705, USA
| | - Corrine I Voils
- William Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA.,Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, K6/100 Clinical Science CEnter, 600 Highland Ave, Madison, WI, 53792, USA
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Lennerz BS, Barton A, Bernstein RK, Dikeman RD, Diulus C, Hallberg S, Rhodes ET, Ebbeling CB, Westman EC, Yancy WS, Ludwig DS. Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet. Pediatrics 2018; 141:peds.2017-3349. [PMID: 29735574 PMCID: PMC6034614 DOI: 10.1542/peds.2017-3349] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD). METHODS We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events. We obtained confirmatory data from diabetes care providers and medical records. RESULTS Of 316 respondents, 131 (42%) were parents of children with T1DM, and 57% were of female sex. Suggestive evidence of T1DM (based on a 3-tier scoring system in which researchers took into consideration age and weight at diagnosis, pancreatic autoimmunity, insulin requirement, and clinical presentation) was obtained for 273 (86%) respondents. The mean age at diagnosis was 16 ± 14 years, the duration of diabetes was 11 ± 13 years, and the time following a VLCD was 2.2 ± 3.9 years. Participants had a mean daily carbohydrate intake of 36 ± 15 g. Reported mean HbA1c was 5.67% ± 0.66%. Only 7 (2%) respondents reported diabetes-related hospitalizations in the past year, including 4 (1%) for ketoacidosis and 2 (1%) for hypoglycemia. CONCLUSIONS Exceptional glycemic control of T1DM with low rates of adverse events was reported by a community of children and adults who consume a VLCD. The generalizability of these findings requires further studies, including high-quality randomized controlled trials.
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Affiliation(s)
- Belinda S. Lennerz
- Division of Endocrinology, and,New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Anna Barton
- Richmond Diabetes and Endocrinology, Bon Secours Medical Group, Richmond, Virginia
| | | | | | | | - Sarah Hallberg
- Virta Health and Indiana University Health, School of Medicine, Indiana University, Indianapolis, Indiana; and
| | | | - Cara B. Ebbeling
- Division of Endocrinology, and,New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - David S. Ludwig
- Division of Endocrinology, and,New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
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Tay J, Thompson CH, Luscombe-Marsh ND, Wycherley TP, Noakes M, Buckley JD, Wittert GA, Yancy WS, Brinkworth GD. Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial. Diabetes Obes Metab 2018; 20:858-871. [PMID: 29178536 DOI: 10.1111/dom.13164] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 12/20/2022]
Abstract
AIM To examine whether a low-carbohydrate, high-unsaturated/low-saturated fat diet (LC) improves glycaemic control and cardiovascular disease (CVD) risk factors in overweight and obese patients with type 2 diabetes (T2D). METHODS A total of 115 adults with T2D (mean [SD]; BMI, 34.6 [4.3] kg/m2 ; age, 58 [7] years; HbA1c, 7.3 [1.1]%) were randomized to 1 of 2 planned energy-matched, hypocaloric diets combined with aerobic/resistance exercise (1 hour, 3 days/week) for 2 years: LC: 14% energy as carbohydrate, 28% as protein, 58% as fat (<10% saturated fat); or low-fat, high-carbohydrate, low-glycaemic index diet (HC): 53% as CHO, 17% as protein, 30% as fat (<10% saturated fat). HbA1c, glycaemic variability (GV), anti-glycaemic medication effect score (MES, calculated based on the potency and dosage of diabetes medication), weight, body composition, CVD and renal risk markers were assessed before and after intervention. RESULTS A total of 61 (LC = 33, HC = 28) participants completed the study (trial registration: http://www.anzctr.org.au/, ANZCTR No. ACTRN12612000369820). Reductions in weight (estimated marginal mean [95% CI]; LC, -6.8 [-8.8,-4.7], HC, -6.6 [-8.8, -4.5] kg), body fat (LC, -4.3 [-6.2, -2.4], HC, -4.6 [-6.6, -2.7] kg), blood pressure (LC, -2.0 [-5.9, 1.8]/ -1.2 [-3.6, 1.2], HC, -3.2 [-7.3, 0.9]/ -2.0 [-4.5, 0.5] mmHg), HbA1c (LC, -0.6 [-0.9, -0.3], HC, -0.9 [-1.2, -0.5] %) and fasting glucose (LC, 0.3 [-0.4, 1.0], HC, -0.4 [-1.1, 0.4] mmol/L) were similar between groups (P ≥ 0.09). Compared to HC, the LC achieved greater reductions in diabetes medication use (MES; LC, -0.5 [-0.6, -0.3], HC, -0.2 [-0.4, -0.02] units; P = 0.03), GV (Continuous Overall Net Glycemic Action calculated every 1 hour (LC, -0.4 [-0.6, -0.3], HC, -0.1 [-0.1, 0.2] mmol/L; P = 0.001), and 4 hours (LC, -0.9 [-1.3, -0.6], HC, -0.2 [-0.6, 0.1] mmol/L; P = 0.02)); triglycerides (LC, -0.1 [-0.3, 0.2], HC, 0.1 [-0.2, 0.3] mmol/L; P = 0.001), and maintained HDL-C levels (LC, 0.02 [-0.05, 0.1], HC, -0.1 [-0.1, 0.01] mmol/L; P = 0.004), but had similar changes in LDL-C (LC, 0.2 [-0.1, 0.5], HC, 0.1 [-0.2, 0.4] mmol/L; P = 0.85), brachial artery flow mediated dilatation (LC, -0.5 [-1.5, 0.5], HC, -0.4 [-1.4, 0.7] %; P = 0.73), eGFR and albuminuria. CONCLUSIONS Both diets achieved comparable weight loss and HbA1c reductions. The LC sustained greater reductions in diabetes medication requirements, and in improvements in diurnal blood glucose stability and blood lipid profile, with no adverse renal effects, suggesting greater optimization of T2D management.
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Affiliation(s)
- Jeannie Tay
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
- Agency for Science, Technology and Research (A-STAR), Singapore
| | | | - Natalie D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
| | - Thomas P Wycherley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Gary A Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - William S Yancy
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
| | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia
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Taylor SS, Hughes JM, Coffman CJ, Jeffreys AS, Ulmer CS, Oddone EZ, Bosworth HB, Yancy WS, Allen KD. Prevalence of and characteristics associated with insomnia and obstructive sleep apnea among veterans with knee and hip osteoarthritis. BMC Musculoskelet Disord 2018; 19:79. [PMID: 29523117 PMCID: PMC5845198 DOI: 10.1186/s12891-018-1993-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/26/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few studies have examined patterns of specific sleep problems among individuals with osteoarthritis (OA). The primary objective of this study was to examine prevalence of symptoms of insomnia and obstructive sleep apnea (OSA) among Veterans with OA. Secondary objectives were to assess proportions of individuals with insomnia and OSA symptoms who may have been undiagnosed and to examine Veterans' characteristics associated with insomnia and OSA symptoms. METHODS Veterans (n = 300) enrolled in a clinical trial completed the Insomnia Severity Index (ISI) and the Berlin Questionnaire (BQ) at baseline; proportions of participants with symptoms consistent with insomnia and OSA were calculated, using standard cut-offs for ISI and BQ. For Veterans with insomnia and OSA symptoms, electronic medical records were searched to identify whether there was a diagnosis code for these conditions. Multivariable linear (ISI) and logistic (BQ) regression models examined associations of the following characteristics with symptoms of insomnia and OSA: age, gender, race, self-reported general health, body mass index (BMI), diagnosis of post-traumatic stress disorder (PTSD), pain severity, depressive symptoms, number of joints with arthritis symptoms and opioid use. RESULTS Symptoms consistent with insomnia and OSA were found in 53 and 66% of this sample, respectively. Among participants screening positive for insomnia and OSA, diagnosis codes for these disorders were present in the electronic medical record for 22 and 51%, respectively. Characteristics associated with insomnia were lower age (β (SE) = - 0.09 (0.04), 95% confidence interval [CI] = - 0.16, - 0.02), having a PTSD diagnosis (β (SE) = 1.68 (0.73), CI = 0.25, 3.11), greater pain severity (β (SE) = 0.36 (0.09), CI = 0.17, 0.55), and greater depressive symptoms (β (SE) = 0.84 (0.07), CI = 0.70, 0.98). Characteristics associated with OSA were higher BMI (odds ratio [OR] = 1.13, CI = 1.06, 1.21), greater depressive symptoms (OR = 1.12, CI = 1.05, 1.20), and opioid use (OR = 0.51, CI = 0.26, 0.99). CONCLUSIONS Insomnia and OSA symptoms were very common in Veterans with OA, and a substantial proportion of individuals with symptoms may have been undiagnosed. Characteristics associated with insomnia and OSA symptoms were consistent with prior studies. TRIAL REGISTRATION NCT01130740 .
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Affiliation(s)
- Shannon Stark Taylor
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605 USA
| | - Jaime M. Hughes
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
| | - Cynthia J. Coffman
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- Duke University School of Medicine, Durham, NC USA
| | - Amy S. Jeffreys
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
| | - Christi S. Ulmer
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- Duke University School of Medicine, Durham, NC USA
| | - Eugene Z. Oddone
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- Duke University School of Medicine, Durham, NC USA
| | - Hayden B. Bosworth
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- Duke University School of Medicine, Durham, NC USA
| | - William S. Yancy
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- Duke University School of Medicine, Durham, NC USA
| | - Kelli D. Allen
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Voils CI, Levine E, Gierisch JM, Pendergast J, Hale SL, McVay MA, Reed SD, Yancy WS, Bennett G, Strawbridge EM, White AC, Shaw RJ. Study protocol for Log2Lose: A feasibility randomized controlled trial to evaluate financial incentives for dietary self-monitoring and interim weight loss in adults with obesity. Contemp Clin Trials 2018; 65:116-122. [PMID: 29289702 PMCID: PMC5803330 DOI: 10.1016/j.cct.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/08/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
The obesity epidemic has negative physical, psychological, and financial consequences. Despite the existence of effective behavioral weight loss interventions, many individuals do not achieve adequate weight loss, and most regain lost weight in the year following intervention. We report the rationale and design for a 2×2 factorial study that involves financial incentives for dietary self-monitoring (yes vs. no) and/or interim weight loss (yes vs. no). Outpatients with obesity participate in a 24-week, group-based weight loss intervention. All participants are asked to record their daily dietary and liquid intake on a smartphone application (app) and to weigh themselves daily at home on a study-provided cellular scale. An innovative information technology (IT) solution collates dietary data from the app and weight from the scale. Using these data, an algorithm classifies participants weekly according to whether they met their group's criteria to receive a cash reward ranging from $0 to $30 for dietary self-monitoring and/or interim weight loss. Notice of the reward is provided via text message, and credit is uploaded to a gift card. This pilot study will provide information on the feasibility of using this novel IT solution to provide variable-ratio financial incentives in real time via its effects on recruitment, intervention adherence, retention, and cost. This study will provide the foundation for a comprehensive, adequately-powered, randomized controlled trial to promote short-term weight loss and long-term weight maintenance. If efficacious, this approach could reduce the prevalence, adverse outcomes, and costs of obesity for millions of Americans. Clinicaltrials.gov registration: NCT02691260.
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Affiliation(s)
- Corrine I Voils
- William S Middleton Memorial Veterans Hospital, USA; University of Wisconsin School of Medicine and Public Health, USA.
| | | | | | | | | | | | | | | | - Gary Bennett
- Duke University Medical School, USA; University of Florida, USA
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Batch BC, Goldstein K, Yancy WS, Sanders LL, Danus S, Grambow SC, Bosworth HB. Outcome by Gender in the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere Weight Management Program. J Womens Health (Larchmt) 2017; 27:32-39. [PMID: 28731844 DOI: 10.1089/jwh.2016.6212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Few evaluations of the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere (MOVE!) weight management program have assessed 6-month weight change or factors associated with weight change by gender. MATERIALS AND METHODS Analysis of administrative data from a national sample of veterans in the VA MOVE! PROGRAM RESULTS A total of 62,882 participants were included, 14.6% were women. Compared with men, women were younger (49.6 years [standard deviation, SD, 10.8] vs. 59.3 years [SD, 9.8], p < 0.0001), less likely to be married (34.1% vs. 56.0%, p < 0.0001), and had higher rates of post-traumatic stress disorder (26.0% vs. 22.4%, p < 0.0001) and depression (49.3% vs. 32.9%, p < 0.001). The mean number of MOVE! visits attended by women was lower than men (5.6 [SD, 5.3] vs. 6.0 [SD, 5.9], p < 0.0001). Women, compared with men, reported lower rates of being able to rely on family or friends (35.7% vs. 40.8%, p < 0.0001). Observed mean percent change in weight for women was -1.5% (SD, 5.2) and for men was -1.9% (SD, 4.8, p < 0.0001). The odds of ≥5% weight loss were no different for women (body-mass index [BMI] >25 kg/m2) compared with men (BMI >25 kg/m2; odds ratio, 1.05 [95% confidence interval, 0.99-1.11; p = 0.13]). CONCLUSIONS Women veterans lost less weight overall compared with men. There was no difference in the odds of achieving clinically significant weight loss by gender. The majority of women and men enrolled lost <5% weight despite being enrolled in a lifestyle intervention. Future studies should focus on identifying program- and participant-level barriers to weight loss.
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Affiliation(s)
- Bryan C Batch
- 1 Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - Karen Goldstein
- 2 Center for Health Services Research in Primary Care, Durham VA Medical Center , Durham, North Carolina.,3 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - William S Yancy
- 2 Center for Health Services Research in Primary Care, Durham VA Medical Center , Durham, North Carolina.,3 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina.,4 Duke University Diet and Fitness Center, Duke University Health System , Durham, North Carolina
| | - Linda L Sanders
- 3 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina
| | - Susanne Danus
- 2 Center for Health Services Research in Primary Care, Durham VA Medical Center , Durham, North Carolina
| | - Steven C Grambow
- 5 Department of Biostatistics and Bioinformatics, Duke University Medical Center , Durham, North Carolina
| | - Hayden B Bosworth
- 2 Center for Health Services Research in Primary Care, Durham VA Medical Center , Durham, North Carolina.,3 Division of General Internal Medicine, Department of Medicine, Duke University Medical Center , Durham, North Carolina.,6 Department of Psychiatry and Behavioral Sciences, School of Nursing, Duke University , Durham, North Carolina
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Maciejewski ML, Arterburn DE, Van Scoyoc L, Smith VA, Yancy WS, Weidenbacher HJ, Livingston EH, Olsen MK. Bariatric Surgery and Long-term Durability of Weight Loss. JAMA Surg 2017; 151:1046-1055. [PMID: 27579793 DOI: 10.1001/jamasurg.2016.2317] [Citation(s) in RCA: 390] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Bariatric surgery induces significant weight loss for severely obese patients, but there is limited evidence of the durability of weight loss compared with nonsurgical matches and across bariatric procedures. Objectives To examine 10-year weight change in a large, multisite, clinical cohort of veterans who underwent Roux-en-Y gastric bypass (RYGB) compared with nonsurgical matches and the 4-year weight change in veterans who underwent RYGB, adjustable gastric banding (AGB), or sleeve gastrectomy (SG). Design, Setting, and Participants In this cohort study, differences in weight change up to 10 years after surgery were estimated in retrospective cohorts of 1787 veterans who underwent RYGB from January 1, 2000, through September 30, 2011 (573 of 700 eligible [81.9%] with 10-year follow-up), and 5305 nonsurgical matches (1274 of 1889 eligible [67.4%] with 10-year follow-up) in mixed-effects models. Differences in weight change up to 4 years were compared among veterans undergoing RYGB (n = 1785), SG (n = 379), and AGB (n = 246). Data analysis was performed from September 9, 2014, to February 12, 2016. Exposures Bariatric surgical procedures and usual care. Main Outcomes and Measures Weight change up to 10 years after surgery through December 31, 2014. Results The 1787 patients undergoing RYGB had a mean (SD) age of 52.1 (8.5) years and 5305 nonsurgical matches had a mean (SD) age of 52.2 (8.4) years. Patients undergoing RYGB and nonsurgical matches had a mean body mass index of 47.7 and 47.1, respectively, and were predominantly male (1306 [73.1%] and 3911 [73.7%], respectively). Patients undergoing RYGB lost 21% (95% CI, 11%-31%) more of their baseline weight at 10 years than nonsurgical matches. A total of 405 of 564 patients undergoing RYGB (71.8%) had more than 20% estimated weight loss, and 224 of 564 (39.7%) had more than 30% estimated weight loss at 10 years compared with 134 of 1247 (10.8%) and 48 of 1247 (3.9%), respectively, of nonsurgical matches. Only 19 of 564 patients undergoing RYGB (3.4%) regained weight back to within an estimated 5% of their baseline weight by 10 years. At 4 years, patients undergoing RYGB lost 27.5% (95% CI, 23.8%-31.2%) of their baseline weight, patients undergoing AGB lost 10.6% (95% CI, 0.6%-20.6%), and patients undergoing SG lost 17.8% (95% CI, 9.7%-25.9%). Patients undergoing RYGB lost 16.9% (95% CI, 6.2%-27.6%) more of their baseline weight than patients undergoing AGB and 9.7% (95% CI, 0.8%-18.6%) more than patients undergoing SG. Conclusions and Relevance Patients in the Veterans Administration health care system lost substantially more weight than nonsurgical matches and sustained most of this weight loss in the long term. Roux-en-Y gastric bypass induced significantly greater weight loss among veterans than SG or AGB at 4 years. These results provide further evidence of the beneficial association between surgery and long-term weight loss that has been demonstrated in shorter-term studies of younger, predominantly female populations.
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Affiliation(s)
- Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina2Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - David E Arterburn
- Group Health Research Institute, Seattle, Washington4Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Lynn Van Scoyoc
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Valerie A Smith
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina2Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - William S Yancy
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina2Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Hollis J Weidenbacher
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Edward H Livingston
- Veterans Administration North Texas Health Care System, Dallas, Texas6Division of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern Medical Center, Dallas7Division of General Surgery, Northwestern University, Chicago, Illinois8Deputy Editor, JAMA
| | - Maren K Olsen
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina9Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
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Crowley MJ, Edelman D, Voils CI, Maciejewski ML, Coffman CJ, Jeffreys AS, Turner MJ, Gaillard LA, Hinton TA, Strawbridge E, Zervakis J, Barton AB, Yancy WS. Jump starting shared medical appointments for diabetes with weight management: Rationale and design of a randomized controlled trial. Contemp Clin Trials 2017; 58:1-12. [PMID: 28445783 DOI: 10.1016/j.cct.2017.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/03/2017] [Accepted: 04/10/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Rates of glycemic control remain suboptimal nationwide. Medication intensification for diabetes can have undesirable side effects (weight gain, hypoglycemia), which offset the benefits of glycemic control. A Shared Medical Appointment (SMA) intervention for diabetes that emphasizes weight management could improve glycemic outcomes and reduce weight while simultaneously lowering diabetes medication needs, resulting in less hypoglycemia and better quality of life. We describe the rationale and design for a study evaluating a novel SMA intervention for diabetes that primarily emphasizes low-carbohydrate diet-focused weight management. METHODS Jump Starting Shared Medical Appointments for Diabetes with Weight Management (Jump Start) is a randomized, controlled trial that is allocating overweight Veterans (body mass index≥27kg/m2) with type 2 diabetes into two arms: 1) a traditional SMA group focusing on medication management and self-management counseling; or 2) an SMA group that combines low-carbohydrate diet-focused weight management (WM/SMA) with medication management. Hemoglobin A1c reduction at 48weeks is the primary outcome. Secondary outcomes include hypoglycemic events, diabetes medication use, weight, medication adherence, diabetes-related quality of life, and cost-effectiveness. We hypothesize that WM/SMA will be non-inferior to standard SMA for glycemic control, and will reduce hypoglycemia, diabetes medication use, and weight relative to standard SMA, while also improving quality of life and costs. CONCLUSIONS Jump Start targets two common problems that are closely related but infrequently managed together: diabetes and obesity. By focusing on diet and weight loss as the primary means to control diabetes, this intervention may improve several meaningful patient-centered outcomes related to diabetes.
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Affiliation(s)
- Matthew J Crowley
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, United States.
| | - David Edelman
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States
| | - Corrine I Voils
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States
| | - Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States
| | - Cynthia J Coffman
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States
| | - Amy S Jeffreys
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Marsha J Turner
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Leslie A Gaillard
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Teresa A Hinton
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Elizabeth Strawbridge
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Jennifer Zervakis
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States
| | - Anna Beth Barton
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, NC, United States
| | - William S Yancy
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, United States; Duke Diet and Fitness Center, Durham, NC, United States
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Voils CI, Olsen MK, Gierisch JM, McVay MA, Grubber JM, Gaillard L, Bolton J, Maciejewski ML, Strawbridge E, Yancy WS. Maintenance of Weight Loss After Initiation of Nutrition Training: A Randomized Trial. Ann Intern Med 2017; 166:463-471. [PMID: 28241185 PMCID: PMC5483942 DOI: 10.7326/m16-2160] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Weight regain after successful weight loss interventions is common. OBJECTIVE To establish the efficacy of a weight loss maintenance program compared with usual care in obese adults. DESIGN 2-group, parallel, randomized trial stratified by initial weight loss (<10 kg vs. ≥10 kg), conducted from 20 August 2012 to 18 December 2015. Outcome assessors were blinded to treatment assignment. (ClinicalTrials.gov: NCT01357551). SETTING 3 primary care clinics at the Veterans Affairs Medical Center in Durham and Raleigh, North Carolina. PATIENTS Obese outpatients (body mass index ≥30 kg/m2) who lost 4 kg or more of body weight during a 16-week, group-based weight loss program. INTERVENTION The maintenance intervention, delivered primarily by telephone, addressed satisfaction with outcomes, relapse-prevention planning, self-monitoring, and social support. Usual care involved no contact except for study measurements. MEASUREMENTS Primary outcome was mean weight regain at week 56. Secondary outcomes included self-reported caloric intake, walking, and moderate physical activity. RESULTS Of 504 patients in the initial program, 222 lost at least 4 kg of body weight and were randomly assigned to maintenance (n = 110) or usual care (n = 112). Retention was 85%. Most patients were middle-aged white men. Mean weight loss during initiation was 7.2 kg (SD, 3.1); mean weight at randomization was 103.6 kg (SD, 20.4). Estimated mean weight regain was statistically significantly lower in the intervention (0.75 kg) than the usual care (2.36 kg) group (estimated mean difference, 1.60 kg [95% CI, 0.07 to 3.13 kg]; P = 0.040). No statistically significant differences in secondary outcomes were seen at 56 weeks. No adverse events directly attributable to the intervention were observed. LIMITATIONS Results may not generalize to other settings or populations. Dietary intake and physical activity were self-reported. Duration was limited to 56 weeks. CONCLUSION An intervention focused on maintenance-specific strategies and delivered in a resource-conserving way modestly slowed the rate of weight regain in obese adults. PRIMARY FUNDING SOURCE Veterans Affairs Health Services Research and Development Service.
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Affiliation(s)
- Corrine I Voils
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Maren K Olsen
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Jennifer M Gierisch
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Megan A McVay
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Janet M Grubber
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Leslie Gaillard
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Jamiyla Bolton
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Matthew L Maciejewski
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - Elizabeth Strawbridge
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
| | - William S Yancy
- From Durham Veterans Affairs Medical Center, Duke University Medical Center, and Duke University Diet and Fitness Center, Durham, North Carolina
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Allen KD, Oddone EZ, Coffman CJ, Jeffreys AS, Bosworth HB, Chatterjee R, McDuffie J, Strauss JL, Yancy WS, Datta SK, Corsino L, Dolor RJ. Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial. Ann Intern Med 2017; 166:401-411. [PMID: 28114648 PMCID: PMC6862719 DOI: 10.7326/m16-1245] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. OBJECTIVE To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes. DESIGN Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109). SETTING 10 Duke University Health System community-based primary care clinics. PARTICIPANTS 537 outpatients with symptomatic hip or knee osteoarthritis. INTERVENTION The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers. MEASUREMENTS The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups. RESULTS No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. LIMITATIONS The study involved 1 health care network. Data on provider referrals were not collected. CONCLUSION Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically significant improvements in the osteoarthritis intervention groups compared with usual care. PRIMARY FUNDING SOURCE National Institute of Arthritis and Musculoskeletal and Skin Diseases.
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Affiliation(s)
- Kelli D Allen
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Eugene Z Oddone
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Cynthia J Coffman
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Amy S Jeffreys
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Hayden B Bosworth
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Ranee Chatterjee
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer McDuffie
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer L Strauss
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - William S Yancy
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Santanu K Datta
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Leonor Corsino
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
| | - Rowena J Dolor
- From Durham Veterans Affairs Medical Center, Duke University, and Duke University Medical Center, Durham, and University of North Carolina, Chapel Hill, North Carolina
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John LK, Troxel AB, Yancy WS, Friedman J, Zhu J, Yang L, Galvin R, Miller-Kovach K, Halpern SD, Loewenstein G, Volpp K. The Effect of Cost Sharing on an Employee Weight Loss Program: A Randomized Trial. Am J Health Promot 2016; 32:170-176. [DOI: 10.1177/0890117116671282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To test the effects of employer subsidies on employee enrollment, attendance, and weight loss in a nationally available weight management program. Design: A randomized trial tested the impact of employer subsidy: 100%; 80%, 50%, and a hybrid 50% subsidy that could become a 100% subsidy by attaining attendance targets. Trial registration: NCT01756066. Setting and Participants: Twenty three thousand twenty-three employees of 2 US companies. Measures: The primary outcome was the percentage of employees who enrolled in the weight management program. We also tested whether the subsidies were associated with differential attendance and weight loss over 12 months, as might be predicted by the expectation that they attract employees with differing degrees of motivation. Analysis and Results: Enrollment differed significantly by subsidy level ( P < .0001). The 100% subsidy produced the highest enrollment (7.7%), significantly higher than each of the lower subsidies (vs 80% subsidy: 6.2%, P = .002; vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Enrollment in the 80% subsidy group was significantly higher than both lower subsidy groups (vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Among enrollees, there were no differences among the 4 groups in attendance or weight loss. Conclusion: This pragmatic trial, conducted in a real-world workplace setting, suggests that higher rates of employer subsidization help individuals to enroll in weight loss programs, without a decrement in program effectiveness. Future research could explore the cost-effectiveness of such subsidies or alternative designs.
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Affiliation(s)
- Leslie K. John
- Negotiations, Organizations and Markets Unit, Harvard Business School, Boston, MA, USA
| | - Andrea B. Troxel
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - William S. Yancy
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Joelle Friedman
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Lin Yang
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | | | | | - Scott D. Halpern
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
- Cresencz Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - George Loewenstein
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Kevin Volpp
- Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
- Cresencz Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
- Department of Health Care Management, The Wharton School, Philadelphia, PA, USA
- Departments of Medicine and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Shaw PA, Yancy WS, Wesby L, Ulrich V, Troxel AB, Huffman D, Foster GD, Volpp K. The design and conduct of Keep It Off: An online randomized trial of financial incentives for weight-loss maintenance. Clin Trials 2016; 14:29-36. [PMID: 27646508 DOI: 10.1177/1740774516669679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Obesity continues to be a serious public health challenge. Rates are increasing worldwide, with nearly 70% of the US adults overweight or obese, leading to increased clinical and economic burden. While successful approaches for achieving weight loss have been identified, techniques for long-term maintenance of initial weight loss have largely been unsuccessful. Financial incentive interventions have been shown in several settings to be successful in motivating participants to adopt healthy behaviors. Purpose Keep It Off is a three-arm randomized controlled trial that compares the efficacy of a lottery-based incentive, traditional direct payment incentive, and control of daily feedback without any incentive for weight-loss maintenance. This design allows comparison of a traditional direct payment incentive with one based on behavioral economic principles that consider the underlying psychology of decision-making. Methods Participants were randomized in a 2:1 ratio for each active arm relative to control, with a targeted 188 participants in total. Eligible participants were those aged 30-80 who lost at least 11 lb (5 kg) during the first 4 months of participation in Weight Watchers, a national weight-loss program, with whom we partnered. The interventions lasted 6 months (Phase I); participants were followed for an additional 6 months without intervention (Phase II). The primary outcome is weight change from baseline to the end of Phase I, with the change at the end of Phase II a key secondary endpoint. Keep It Off is a pragmatic trial that recruited, consented, enrolled, and followed patients electronically. Participants were provided a wireless weight scale that electronically transmitted daily self-monitored weights. Weights were verified every 3 months at a Weight Watchers center local to the participant and electronically transmitted. Results Using the study web-based platform, we integrated recruitment, enrollment, and follow-up procedures into a digital platform that required little staff effort to implement and manage. We randomized 191 participants in less than 1 year. We describe the design of Keep It Off and implementation of enrollment. Lessons Learned We demonstrated that our pragmatic design was successful in rapid accrual of participants in a trial of interventions to maintain weight loss. Limitations Despite the nationwide reach of Weight Watchers, the generalizability of study findings may be limited by the characteristics of its members. The interventions under study are appropriate for settings where an entity, such as an employer or health insurance company, could offer them as a benefit. Conclusions Keep It Off was implemented and conducted with minimal staff effort. This study has the potential to identify a practical and effective weight-loss maintenance strategy.
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Affiliation(s)
- Pamela A Shaw
- 1 Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,2 Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,3 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William S Yancy
- 4 Department of Medicine, Duke University Medical Center, Durham, NC, USA.,5 Center for Health Services Research in Primary Care, US Department of Veterans Affairs, Durham, NC, USA
| | - Lisa Wesby
- 2 Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,3 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Ulrich
- 2 Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,3 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea B Troxel
- 1 Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,2 Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,3 Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David Huffman
- 2 Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,6 Department of Economics, University of Oxford, Oxford, UK
| | - Gary D Foster
- 7 Department of Science and Innovation, Weight Watchers International, New York, NY, USA.,8 Center for Obesity Research and Education, Temple University, Philadelphia, PA, USA
| | - Kevin Volpp
- 2 Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,9 Center for Health Equity Research & Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.,10 Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,11 Department of Health Care Systems, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
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Voils CI, Grubber JM, McVay MA, Olsen MK, Bolton J, Gierisch JM, Taylor SS, Maciejewski ML, Yancy WS. Recruitment and Retention for a Weight Loss Maintenance Trial Involving Weight Loss Prior to Randomization. Obes Sci Pract 2016; 2:355-365. [PMID: 28090340 PMCID: PMC5192533 DOI: 10.1002/osp4.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/27/2016] [Accepted: 07/10/2016] [Indexed: 01/06/2023] Open
Abstract
Objective A weight loss maintenance trial involving weight loss prior to randomization is challenging to implement due to the potential for dropout and insufficient weight loss. We examined rates and correlates of non‐initiation, dropout, and insufficient weight loss during a weight loss maintenance trial. Methods The MAINTAIN trial involved a 16‐week weight loss program followed by randomization among participants losing at least 4 kg. Psychosocial measures were administered during a screening visit. Weight was obtained at the first group session and 16 weeks later to determine eligibility for randomization. Results Of 573 patients who screened as eligible, 69 failed to initiate the weight loss program. In adjusted analyses, failure to initiate was associated with lower age, lack of a support person, and less encouragement for making dietary changes. Among participants who initiated, 200 dropped out, 82 lost insufficient weight, and 222 lost sufficient weight for randomization. Compared to losing sufficient weight, dropping out was associated with younger age and tobacco use, whereas losing insufficient weight was associated with non‐White race and controlled motivation for physical activity. Conclusions Studies should be conducted to evaluate strategies to maximize recruitment and retention of subgroups that are less likely to initiate and be retained in weight loss maintenance trials.
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Affiliation(s)
- C I Voils
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Medicine Duke University Medical Center Durham NC USA
| | - J M Grubber
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA
| | - M A McVay
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Psychiatry Duke University Medical Center Durham NC USA
| | - M K Olsen
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Biostatistics and Bioinformatics Duke University Medical Center Durham NC USA
| | - J Bolton
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA
| | - J M Gierisch
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Medicine Duke University Medical Center Durham NC USA
| | - S S Taylor
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA
| | - M L Maciejewski
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Medicine Duke University Medical Center Durham NC USA
| | - W S Yancy
- Center for Health Services Research in Primary Care Durham Veterans Affairs Medical Center Durham NC USA; Department of Medicine Duke University Medical Center Durham NC USA
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Cox DJ, Taylor AG, Moncrief M, Diamond A, Yancy WS, Hegde S, McCall AL. Continuous Glucose Monitoring in the Self-management of Type 2 Diabetes: A Paradigm Shift. Diabetes Care 2016; 39:e71-3. [PMID: 26989181 DOI: 10.2337/dc15-2836] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/15/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Daniel J Cox
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Ann G Taylor
- University of Virginia School of Nursing, Charlottesville, VA
| | - Matthew Moncrief
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Anne Diamond
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, Charlottesville, VA
| | - William S Yancy
- Durham Veterans Affairs Medical Center, Duke University School of Medicine, Durham, NC
| | - Shefali Hegde
- Center for Behavioral Medicine Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Anthony L McCall
- Division of Endocrinology and Metabolism, University of Virginia School of Medicine, Charlottesville, VA
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50
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McVay MA, Voils CI, Geiselman PJ, Smith VA, Coffman CJ, Mayer S, Yancy WS. Food preferences and weight change during low-fat and low-carbohydrate diets. Appetite 2016; 103:336-343. [PMID: 27133551 DOI: 10.1016/j.appet.2016.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/19/2016] [Accepted: 04/27/2016] [Indexed: 11/24/2022]
Abstract
UNLABELLED Understanding associations between food preferences and weight loss during various effective diets could inform efforts to personalize dietary recommendations and provide insight into weight loss mechanisms. We conducted a secondary analysis of data from a clinical trial in which participants were randomized to either a 'choice' arm, in which they were allowed to select between a low-fat diet (n = 44) or low-carbohydrate diet (n = 61), or to a 'no choice' arm, in which they were randomly assigned to a low-fat diet (n = 49) or low-carbohydrate diet (n = 53). All participants were provided 48 weeks of lifestyle counseling. Food preferences were measured at baseline and every 12 weeks thereafter with the Geiselman Food Preference Questionnaire. Participants were 73% male and 51% African American, with a mean age of 55. Baseline food preferences, including congruency of food preferences with diet, were not associated with weight outcomes. In the low-fat diet group, no associations were found between changes in food preferences and weight over time. In the low-carbohydrate diet group, increased preference for low-carbohydrate diet congruent foods from baseline to 12 weeks was associated with weight loss from 12 to 24 weeks. Additionally, weight loss from baseline to 12 weeks was associated with increased preference for low-carbohydrate diet congruent foods from 12 to 24 weeks. Results suggest that basing selection of low-carbohydrate diet or low-fat diet on food preferences is unlikely to influence weight loss. Congruency of food preferences and weight loss may influence each other early during a low-carbohydrate diet but not low-fat diet, possibly due to different features of these diets. CLINICAL TRIAL REGISTRY NCT01152359.
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Affiliation(s)
- Megan A McVay
- Division of Behavioral Medicine, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States; Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States.
| | - Corrine I Voils
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Paula J Geiselman
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States; Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Valerie A Smith
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
| | - Cynthia J Coffman
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, United States
| | - Stephanie Mayer
- Division of Endocrinology and Metabolism, Virginia Commonwealth University, Richmond, VA, United States
| | - William S Yancy
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, United States; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, United States
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