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Brown KL, LaRose JG, Raynor HA, Gorin AA, Thornton LM, Farthing S, Tatum K, Bean MK. Study design and rationale for TEENS+REACH: Evaluating ripple effects of a family-based lifestyle intervention to untreated family members. Contemp Clin Trials Commun 2024; 38:101276. [PMID: 38404649 PMCID: PMC10884803 DOI: 10.1016/j.conctc.2024.101276] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/04/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
Background Understanding the effects of family-based lifestyle intervention beyond the treated adolescent is important, given that obesity is a familial disease and there are likely bidirectional relations between an adolescent's treatment success and broader household changes. However, it is unknown if recommended household-wide changes are adopted or if untreated family members experience weight-related benefits. Methods TEENS + REACH leverages our ongoing randomized clinical trial of TEENS+, a family-based lifestyle intervention for adolescents with obesity, to determine: 1) if household-wide changes to the shared home environment are implemented, 2) if ripple effects to untreated family members are observed, and 3) whether these changes are predictive of adolescents' weight management success. TEENS + REACH will expand trial assessments to include comprehensive assessments of the shared home feeding, weight, and physical activity environment of the target adolescents. Specifically, we will enroll untreated children (8-17yrs) and caregivers living in the same household as the target parent/adolescent dyad (N = 60 families). At 0, 2, 4 (primary endpoint), and 8-months, the target parent/adolescent dyad and other untreated children and caregivers in the home will complete anthropometric assessments. Discussion Results will determine the familial reach of TEENS+ and reveal potential mediators of treatment response, which can inform future efforts to optimize family-based lifestyle interventions. Trial registration TEENS + REACH was retrospectively registered in Clinicaltrials.gov March 22, 2023 (NCT05780970) as an observational study ancillary to the TEENS + clinical trial, registered February 22, 2019 (NCT03851796).
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Affiliation(s)
- Kristal Lyn Brown
- Department of Health Behavior and Policy, School of Population Health, Virginia Commonwealth University, Box 980430, Richmond, VA, 23298, United States
- Department of Medicine, Johns Hopkins University, School of Medicine, Division of General Internal Medicine, 2024 E Monument St, Baltimore, MD, 21205, United States
- Department of Creative Arts Therapies, Drexel University, College of Nursing and Health Professions, 60 N 36th St, Philadelphia, PA, 19104, United States
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, School of Population Health, Virginia Commonwealth University, Box 980430, Richmond, VA, 23298, United States
| | - Hollie A. Raynor
- Department of Nutrition, University of Tennessee, Knoxville, 1215 W. Cumberland Ave., Knoxville, TN, 37996, United States
| | - Amy A. Gorin
- Department of Psychological Sciences, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, United States
| | - Laura M. Thornton
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, CB#7160 101 Manning Drive, Chapel Hill, NC, 27599-7160, United States
| | - Sarah Farthing
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, United States
| | - Kristina Tatum
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, United States
| | - Melanie K. Bean
- Department of Pediatrics, School of Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA, 23298, United States
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Gilder CM, Gorin AA, Huedo-Medina T, Cooksey-Stowers K, McCaffery JM, Denmat Z, Field C, Wyckoff E, LaRose J, O'Connor K, Marfo N, Leahey TM. Impact of social connectedness on weight loss outcomes in an online program. J Behav Med 2024; 47:144-152. [PMID: 37698801 DOI: 10.1007/s10865-023-00447-1] [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: 05/06/2022] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
Obesity is linked to many negative health consequences. While online behavioral weight loss programs (BWL) are an effective treatment for obesity, weight losses are modest. Social connectedness has been found to improve weight loss outcomes and previous findings suggests that it may be especially important for people of color. The present study investigated the impact of social connectedness (structural connectedness, or network size; relationship quality, and functional connectedness, or social support) on weight loss outcomes in an online BWL program and whether Black race or Hispanic ethnicity moderates the relationship between social connectedness and weight loss. Participants (N = 387) enrolled in a 16-week online BWL program and completed measures of social connectedness before treatment and had their weight measured. Individuals with less structural connectedness (smaller social networks) had greater weight losses. Further, higher levels of functional connectedness (affectionate support, positive support, and relationship quality) mediated the relationship between smaller network size and better weight loss outcomes. Black race / Hispanic ethnicity did not moderate the relationship between social connectedness and weight loss. These findings suggest that the quality of one's relationships, not the size of one's social network, is important for weight loss. Future studies may examine whether online BWL programs that build relationship quality and affectionate and positive support in participants' existing social networks improve overall weight loss outcomes.
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Affiliation(s)
- Carnisha M Gilder
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Amy A Gorin
- Institute for Collaboration on Health, Intervention, and Policy, Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Tania Huedo-Medina
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Kristen Cooksey-Stowers
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Jeanne M McCaffery
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Zeely Denmat
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Christiana Field
- Institute for Collaboration on Health, Intervention, and Policy, Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Emily Wyckoff
- Institute for Collaboration on Health, Intervention, and Policy, Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Jessica LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Kayla O'Connor
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Nana Marfo
- Institute for Collaboration on Health, Intervention, and Policy, Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Tricia M Leahey
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA.
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Gorin AA, Leahey TM, Cornelius T, Bourgea K, Powers TA. Self-control and grit: associations with weight management and healthy habits. J Behav Med 2024; 47:160-167. [PMID: 37440156 DOI: 10.1007/s10865-023-00431-9] [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: 06/10/2022] [Accepted: 06/15/2023] [Indexed: 07/14/2023]
Abstract
Weight management requires resisting immediate temptations in one's environment (self-control) as well as the ability to persevere towards one's long-term goals despite minor setbacks (grit). This study sought to establish relationships between self-control, grit, and behavioral and health outcomes in the context of a couples-based weight management intervention. Couples (n = 64 dyads) in a behaviorally based intervention completed measures of self-control and grit at study entry and the end of treatment (6 months). Habit automaticity for self-weighing and exercise as well as objective weights were measured at baseline, 6 months, and 12 months (maintenance). Self-control and grit increased during treatment; these increases were significantly associated with greater self-weighing habit automaticity at 6 months. Baseline self-control, changes in self-control, and baseline grit were also associated with 6-month exercise automaticity. Only baseline grit was associated with weight loss maintenance. No partner effects were observed. Findings suggest that self-control and grit are malleable constructs that may play an important role in health behavior habits associated with weight management.ClinicalTrials.gov: NCT02570009, October, 7, 2015.
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Affiliation(s)
- Amy A Gorin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269-1248, USA.
| | - Tricia M Leahey
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269-1248, USA
| | - Talea Cornelius
- Division of General Medicine, Columbia University Irving Medical Center, Presbyterian Hospital, 622 W. 168th Street, New York, NY, 10032, USA
| | - Katelyn Bourgea
- Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, 60 Fenwood Road, 02115-6128, Boston, MA, USA
| | - Theodore A Powers
- Department of Psychology, University of Massachusetts Dartmouth, 285 Old Westport Road, 02747, Dartmouth, MA, USA
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Zeldman J, Varela EG, Gorin AA, Gans KM, Gurka MJ, Bernier AV, Mobley AR. Home Visitation Program Staff Attitudes and Intentions Towards Using Digital Technology to Educate Families About Preventing Early Childhood Obesity: A Qualitative Study. Matern Child Health J 2023; 27:1905-1913. [PMID: 37273139 PMCID: PMC10241118 DOI: 10.1007/s10995-023-03731-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Home visitation programs that reach families of young children offer a unique opportunity for large-scale early childhood obesity prevention efforts. The objective of this qualitative research was to determine stakeholder attitudes, subjective norms, perceived ease of use and usefulness, behavioral control, and behavioral intentions towards utilizing technology in a home visitation program targeting early childhood obesity prevention. METHODS Staff from the Florida Maternal, Infant, and Early Childhood Home Visiting Program (n = 27) were interviewed individually by a trained research assistant using a semi-structured script based on constructs from the Technology Acceptance Model and Theory of Planned Behavior. Demographic and technology use information were collected. Interviews were recorded and transcribed verbatim, with data extracted and coded by two trained researchers using a theoretical thematic analysis approach. RESULTS Most of the home visiting staff (78%) were white and non-Hispanic and employed for an average of 5 years with the program. Most staff (85%) indicated they were currently using videoconferencing for home visits. Themes and subthemes emerged, including positive attitudes towards technology as a flexible and time-efficient program alternative for childhood obesity prevention with recommendations to keep content short, at a low literacy level, and available in more than one language for ease of use. Participants recommended developing training tutorials to improve program implementation. Internet access and potential social disconnect were cited as concerns for using technology. DISCUSSION Overall, home visitation staff had positive attitudes and intentions for using technology in home visiting programs with families for early childhood obesity prevention.
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Affiliation(s)
- Jamie Zeldman
- Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA
| | - Elder Garcia Varela
- Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA
| | - Amy A Gorin
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration On Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | - Kim M Gans
- Institute for Collaboration On Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
- Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT, 06269, USA
| | - Matthew J Gurka
- Department of Pediatrics, College of Medicine, University of Florida, 1699 SW 16th Avenue, Gainesville, FL, 32608, USA
| | - Angelina V Bernier
- Department of Pediatrics, College of Medicine, University of Florida, 1699 SW 16th Avenue, Gainesville, FL, 32608, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA.
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Hayes JF, LaRose JG, Gorin AA, Lewis CE, Bahnson J, Phelan S, Wing RR. Weight gain prevention interventions in the Study of Novel Approaches to Weight Gain Prevention (SNAP) trial promote ideal cardiovascular health in young adults. Obesity (Silver Spring) 2023; 31:1530-1537. [PMID: 37157110 DOI: 10.1002/oby.23753] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/27/2023] [Accepted: 02/05/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Cardiovascular health (CVH) declines in young adulthood. This study assessed whether weight gain prevention interventions promoted ideal CVH. METHODS Young adults (n = 599; age 18-35 years; BMI: 21.0-30.9 kg/m2 ) from a randomized controlled trial comparing two weight gain prevention interventions (self-regulation with large or small changes) and a self-guided control group completed anthropometric and clinical assessments at baseline and 2 years. CVH was quantified via the American Heart Association's Life's Simple 7 (LS7) number of ideal components met. RESULTS Both interventions showed significant improvements in the average number of ideal LS7 components met at 2 years compared with control (pre- to post-treatment means; large change: 0.24, small change: 0.34, control: -0.2, p < 0.05). Moreover, a greater percentage of participants in both interventions improved by ≥1 ideal component (large change: 35%, small change: 37%, control: 29%) and a smaller percentage declined by ≥1 ideal component (large change: 16%, small change: 20%, control: 30%) compared with control. For individual LS7 components, the odds of having an ideal BMI and glucose varied by treatment condition at 2 years. CONCLUSIONS Two weight gain prevention interventions led to improvements in ideal CVH at 2 years. Interventions explicitly focused on a broader constellation of LS7 domains might lead to even greater changes in CVH.
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Affiliation(s)
- Jacqueline F Hayes
- Weight Control and Diabetes Research Center, The Miriam Hospital and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Amy A Gorin
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Judy Bahnson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Suzanne Phelan
- Kinesiology and Public Health Department, California Polytechnic State University, San Luis Obispo, California, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital and Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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LaRose JG, Gorin AA, Garcia K, Hayes JF, Tate DF, Espeland MA, Lewis CE, Perdue L, Robichaud E, Hatley K, Wing RR. Life events and stress among young adults in weight gain prevention trial. Health Psychol 2023; 42:314-324. [PMID: 37141017 PMCID: PMC10167549 DOI: 10.1037/hea0001282] [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: 05/05/2023]
Abstract
OBJECTIVE Young adults (YAs) are at high risk for weight gain and show high variability in treatment response. Life events and high perceived stress are common in YAs and could drive less favorable outcomes. The goal was to examine whether life events and stress were related to program engagement and weight outcomes in a weight gain prevention trial for YAs. METHOD Secondary analysis from the Study of Novel Approaches to Weight Gain Prevention (SNAP), a randomized clinical trial (N = 599, 18-35 years, BMI 21-30 kg/m²). Both intervention arms received 10 in-person sessions over 4 months, with long-term contact via web and SMS. Participants completed the CARDIA life events survey and Cohen Perceived Stress Scale-4 at 0 and 4 months; weight was objectively measured at 0, 4 months, and 1, 2, 3, and 4 years. RESULTS Participants who experienced more life events prior to study entry had lower session attendance (p < .01) and retention (p < .01), although no differences in weight outcomes were observed (p = .39). Baseline perceived stress followed a similar pattern. Participants who experienced more life events and higher perceived stress during the initial in-person program (0-4 months) appeared to experience less favorable weight outcomes long-term (p = .05 for life events, p = .04 for stress). Very few associations differed by treatment arm. CONCLUSIONS Experiencing more life events and stress was negatively associated with program engagement and may impair long-term weight outcomes for YAs. Future work should consider identifying YAs at highest risk and tailoring interventions to better meet their needs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Jacqueline F. Hayes
- Weight Control and Diabetes Research Center at the Miriam Hospital
- Alpert Medical School of Brown University
| | - Deborah F. Tate
- University of North Carolina at Chapel Hill
- UNC Lineberger Comprehensive Cancer Center
| | | | | | | | - Erica Robichaud
- Weight Control and Diabetes Research Center at the Miriam Hospital
| | | | - Rena R. Wing
- Weight Control and Diabetes Research Center at the Miriam Hospital
- Alpert Medical School of Brown University
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Crane NT, Butryn ML, Gorin AA, Lowe MR, LaFata EM. Overlapping and distinct relationships between hedonic hunger, uncontrolled eating, food craving, and the obesogenic home food environment during and after a 12-month behavioral weight loss program. Appetite 2023; 185:106543. [PMID: 36940743 PMCID: PMC10121957 DOI: 10.1016/j.appet.2023.106543] [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: 11/10/2022] [Revised: 02/24/2023] [Accepted: 03/17/2023] [Indexed: 03/23/2023]
Abstract
Hedonic hunger, reward-driven eating outside of biological need, is a newer construct in eating behavior research. During behavioral weight loss (BWL), greater improvements in hedonic hunger are associated with higher weight loss, but it remains unclear if hedonic hunger predicts weight loss independent of more well-established, similar constructs (uncontrolled eating and food craving). Research also is needed to understand how hedonic hunger interacts with contextual factors (e.g., obesogenic food environment) during weight loss. Adults (N = 283) in a 12-month randomized controlled trial of BWL were weighed at 0, 12, and 24 months, and completed questionnaires assessing hedonic hunger, food craving, uncontrolled eating, and the home food environment. All variables improved at 12 and 24 months. Decreases in hedonic hunger at 12 months were associated with higher concurrent weight loss, but not when accounting for improvements in craving and uncontrolled eating. At 24 months, reduction in craving was a stronger predictor of weight loss than hedonic hunger, but improvement in hedonic hunger was a stronger predictor of weight loss than change in uncontrolled eating. Changes to the obesogenic home food environment failed to predict weight loss, regardless of levels of hedonic hunger. This study adds novel information on the individual and contextual factors associated with short- and long-term weight control, which can help refine conceptual models and treatment strategies.
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Affiliation(s)
- Nicole T Crane
- Center for Weight, Eating, and Lifestyle Science, Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA, 19104, United States.
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Science, Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA, 19104, United States
| | - Amy A Gorin
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, J.Ryan Building, 2006 Hillside Road, Storrs, CT, 06269, United States
| | - Michael R Lowe
- Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA, 19104, United States
| | - Erica M LaFata
- Center for Weight, Eating, and Lifestyle Science, Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA, 19104, United States
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Tovar A, Fox K, Gans KM, Markham Risica P, Papandonatos GD, Ramirez A, Gorin AA, von Ash T, Jennings E, Bouchard K, McCurdy K. Results from the Strong Families Start at Home/Familias Fuertes Comienzan en Casa: feasibility randomised control trial to improve the diet quality of low-income, predominantly Hispanic/Latinx children. Public Health Nutr 2023; 26:1-15. [PMID: 36691686 PMCID: PMC10131154 DOI: 10.1017/s1368980023000174] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/21/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To describe the feasibility, acceptability and results of Strong Families Start at Home, a 6-month pilot trial of a home-based food parenting/nutrition intervention. DESIGN Pilot randomised controlled trial. SETTING Participants received six visits with a community health worker trained in motivational interviewing (three home visits, three phone calls); an in-home cooking or reading activity; personalised feedback on a recorded family meal or reading activity; text messages and tailored printed materials. PARTICIPANTS Parents and their 2-5-year-old child were randomised into intervention (responsive food parenting practices/nutrition) or control (reading readiness) groups. RESULTS Parents (n 63) were mostly mothers (90 %), Hispanic/Latinx (87 %), born outside the USA (62 %), with household incomes <$25 k (54 %). Despite delivery during COVID-19, 63 % of dyads were retained at 6 months. The intervention was delivered with high fidelity. All parents in the intervention group (n 24) expressed high levels of satisfaction with the intervention, which produced positive treatment effects for whole and total fruit component Healthy Eating Index-2015 scores (point estimate (PE) = 2·14, 95 % CI (0·17, 1·48); PE = 1·71, 95 % CI (0·16, 1·47), respectively) and negative treatment effects for sodium (PE = -2·09, 95 % CI (-1·35, -0·04)). Positive treatment effects also resulted for the following food parenting practices: regular timing of meals and snacks (PE = 1·08, 95 % CI (0·61, 2·00)), reducing distractions during mealtimes (PE = -0·79, 95 % CI (-1·52, -0·19)), using food as a reward (PE = -0·54, 95 % CI (-1·35, -0·04)) and providing a supportive meal environment (PE = 0·73, 95 % CI (0·18, 1·51)). CONCLUSION Given the continued disparities in diet quality among low-income and diverse families, continued efforts to improve child diet quality in fully powered intervention trials are needed.
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Affiliation(s)
- Alison Tovar
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-121S Rm 813, Providence, RI02912, USA
| | - Katelyn Fox
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Kim M Gans
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-121S Rm 813, Providence, RI02912, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Patricia Markham Risica
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-121S Rm 813, Providence, RI02912, USA
| | | | - Andrea Ramirez
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Amy A Gorin
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Tayla von Ash
- Department of Behavioral and Social Sciences, Brown School of Public Health, Box G-121S Rm 813, Providence, RI02912, USA
| | - Ernestine Jennings
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kelly Bouchard
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Karen McCurdy
- Department of Human Development and Family Science, University of Rhode Island, Kingston, RI, USA
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Browne J, Xie H, Wolfe RS, Naslund JA, Gorin AA, Aschbrenner KA. Factors associated with weight gain prevention in young adults with serious mental illness. Early Interv Psychiatry 2023; 17:39-46. [PMID: 35347848 DOI: 10.1111/eip.13289] [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] [Received: 11/03/2021] [Revised: 02/04/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM The purpose of this study was to examine factors associated with weight gain prevention among young adults with serious mental illness who participated in the Fit Forward randomized controlled trial evaluating lifestyle interventions adapted for this high-risk group. The aims were to: (1) examine baseline differences between participants that gained weight and those that lost or maintained weight at six and 12 months, and (2) evaluate whether changes in weight control strategies were associated with weight gain prevention at 6 and 12 months. METHODS This study was a secondary analysis of the Fit Forward Study. Participants were young adults (age 18-35) with a serious mental illness and a body mass index in the overweight or obese range. Participants completed assessments at baseline and 6 and 12 months. t-Tests and chi-squared tests were used to examine baseline differences between those that gained weight and those that lost/maintained weight. Logistic regression was used to evaluate whether changes in weight control strategies were associated with weight gain prevention in the sample overall. RESULTS Lower baseline BMI was significantly associated with weight gain prevention at six and 12 months. Greater increases in weight control strategies total score and psychological coping subscale were significantly associated with weight gain prevention at six and 12 months. CONCLUSIONS Weight control strategies, particularly psychological coping tools that support positive thinking and reduce negative self-talk should be considered as core strategies in healthy lifestyle interventions aimed at preventing weight gain in young adults with serious mental illness.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Haiyi Xie
- Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Rosemarie S Wolfe
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy A Gorin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Cornelius T, Denes A, Webber KT, Guest C, Goldsmith J, Schwartz JE, Gorin AA. Relationship quality and objectively measured physical activity before and after implementation of COVID-19 stay-home orders. J Health Psychol 2022; 27:2390-2401. [PMID: 34435516 PMCID: PMC9364689 DOI: 10.1177/13591053211042075] [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: 11/15/2022] Open
Abstract
In a sample of 28 individuals cohabiting with a partner in NYC, Boston, or Chicago, this study tested whether implementation of stay-home orders to combat the spread of COVID-19 disrupted physical activity and whether high-quality romantic relationships buffered adverse effects. Participants provided FitBit data between February and October, 2020. Stay-home orders were associated with a reduction in daily step counts, B = -1595.72, p = 0.018, increased sedentary minutes, B = 33.75, p = 0.002, and reduced daily minutes of light and moderate physical activity, B = -25.01, p = 0.011; B = -0.72, p = 0.021. No moderation effects emerged.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | | | | | | | - Jeff Goldsmith
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
- Renaissance School of Medicine Stony Brook University, Stony Brook, NY, USA
| | - Amy A. Gorin
- University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
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11
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Hayes JF, Schumacher LM, Lanoye A, LaRose JG, Tate DF, Espeland MA, Gorin AA, Lewis CE, Jelalian E, Wing RR. Persistent, High Levels of Social Jetlag Predict Poor Weight Outcomes in a Weight Gain Prevention Study for Young adults. J Behav Med 2022; 45:794-803. [PMID: 35841487 DOI: 10.1007/s10865-022-00339-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/02/2021] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Social jetlag (SJL), the discrepancy in sleep timing between weekdays and weekends, is associated with higher BMI and cardiometabolic risk and is common in young adults. We examined whether chronic SJL impacts weight gain in young adults participating in a weight gain prevention trial. METHODS Young adults (n = 599, age 18-35; BMI: 21.0-30.9 kg/m2) completed assessments at 0, 4, 12, and 24 months. Multilevel mixed growth models were used to examine (1) associations between demographics and longitudinal SJL and (2) longitudinal SJL as a predictor of weight change and cardiometabolic outcomes. SJL was assessed as a continuous and clinically-significant dichotomous (< vs. ≥2 h) variable. RESULTS 38% of participants had clinically-significant SJL at ≥ 1 timepoints (Baseline M ± SD = 1.3±0.89). Younger (b=-0.05, p < 0.001), female (b = 0.18, p = 0.037) and Black (compared to White, b = 0.23, p = 0.045) participants were more likely to have greater SJL. Individuals with high SJL (≥ 2 h; between-person effect) were more likely to have greater weight gain over 2 years (b = 0.05, p = 0.028). High SJL did not affect the rate of change in waist circumference or cardiometabolic markers over time. CONCLUSIONS High SJL is associated with greater weight gain over time. Reducing SJL may positively impact weight status in young adults.
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Affiliation(s)
- Jacqueline F Hayes
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. .,Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA.
| | - Leah M Schumacher
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
| | - Autumn Lanoye
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.,Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Deborah F Tate
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mark A Espeland
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Amy A Gorin
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elissa Jelalian
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
| | - Rena R Wing
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
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12
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Denes A, Crowley JP, Ponivas ALP, Cornelius T, Allred RJ, Gettens KM, Powers TA, Gorin AA. Evidence of the Associations between Individual and Partner Autonomy Support and Physiological Stress in the Context of Conversations about Weight among Couples Who are Overweight or Obese during a 6-Month Intervention. Health Commun 2022; 37:1013-1021. [PMID: 33563035 PMCID: PMC8349938 DOI: 10.1080/10410236.2021.1880685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The aim of the study was to examine the impact of supportive communication on acute physiological stress responses during weight-related conversations taking place throughout a couples' weight loss program. Participants were 47 married or cohabitating couples where each partner had a BMI of 25-40 kg/m2. Couples were randomized as a dyad into a traditional weight loss program or a program that also included training in providing support to one's partner throughout the weight loss process. Structured conversations between partners about weight management were videotaped at baseline and 6 months. Participants provided saliva samples before and after the conversations, which were assayed for cortisol and salivary alpha-amylase (sAA) to determine physiological stress and anxiety responses to conversations about weight. The results indicated that receiving support from one's partner when discussing weight-related issues was associated with greater physiological stress, as indicated by higher cortisol and sAA levels, whereas providing support to one's partner was associated with lower cortisol levels and higher sAA levels. The findings suggest that receiving support is not a universally positive experience, especially for populations facing health issues. The mixed findings for support provision align with previous studies identifying a negative association between affectionate communication and cortisol levels, as well as a positive association between sAA and anxiety and emotional arousal. The findings and their implications for understanding the physiological correlates of couples' conversations about weight are discussed.
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Affiliation(s)
- Amanda Denes
- Department of Communication, University of Connecticut
| | | | - Ambyre L P Ponivas
- Departments of Communication Studies and Psychology, Young Harris College
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Ryan J Allred
- Department of Communication Studies, University of Wisconsin Oshkosh
| | - Katelyn M Gettens
- Department of Psychiatry, Massachusetts General Hospital
- Department of Neurology, Brigham and Women's Hospital
| | | | - Amy A Gorin
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP) and Psychological Sciences, University of Connecticut
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13
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Leahey TM, Pham J, Denmat Z, Jenkins K, Harris‐Starling C, Gilder C, Gorin AA. Feasibility of online behavioral clinical trials: The future of weight management randomized clinical trials? Obes Sci Pract 2022; 8:811-815. [DOI: 10.1002/osp4.615] [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] [Received: 01/03/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Tricia M. Leahey
- Department of Allied Health Sciences University of Connecticut Storrs Connecticut USA
| | - Julie Pham
- University of Connecticut Institute for Collaboration on Health, Intervention, and Policy Storrs Connecticut USA
| | - Zeely Denmat
- University of Connecticut Institute for Collaboration on Health, Intervention, and Policy Storrs Connecticut USA
| | - Kyrstyn Jenkins
- University of Connecticut Institute for Collaboration on Health, Intervention, and Policy Storrs Connecticut USA
| | - Cheyenne Harris‐Starling
- University of Connecticut Institute for Collaboration on Health, Intervention, and Policy Storrs Connecticut USA
| | - Carnisha Gilder
- University of Connecticut Institute for Collaboration on Health, Intervention, and Policy Storrs Connecticut USA
| | - Amy A. Gorin
- Department of Psychological Sciences University of Connecticut Storrs Connecticut USA
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14
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Leahey TM, Blackman Carr LT, Denmat Z, Fernandes D, Gorin AA. Effectiveness of "run-ins" at predicting adherence in a behavioral weight loss efficacy trial. Contemp Clin Trials 2022; 114:106678. [PMID: 35007787 PMCID: PMC8934261 DOI: 10.1016/j.cct.2022.106678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/15/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/18/2022]
Abstract
There is limited research on whether run-in procedures predict participant adherence during behavioral efficacy trials. This study examined whether information from behavioral run-ins (food diary completion, questionnaire completion, and staff interview) predict intervention adherence, trial retention, and trial outcomes in a behavioral weight loss trial. Using run-in data, trial staff predicted which participants would have high, moderate, or low trial adherence. Participants with predicted high or moderate adherence were randomized. Results showed that predicted high adherers had better intervention adherence (session attendance and completion of self-monitoring records) and superior trial outcomes (i.e. weight loss). Run-in data did not predict trial retention. Results suggest that run-ins may be effective at identifying participants adherent to intervention protocols, thereby enhancing internal validity of behavioral efficacy trials.
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Affiliation(s)
- Tricia M Leahey
- University of Connecticut, Department of Allied Health Sciences, Koons Hall, 358 Mansfield Rd., Unit 1101, Storrs, CT 06269-1101, USA.
| | - Loneke T Blackman Carr
- University of Connecticut, Department of Nutritional Sciences, Roy E. Jones Bldg., 27 Mander Rd., Unit 4017, Storrs, CT 06269-1101, USA.
| | - Zeely Denmat
- University of Connecticut, Institute for Collaboration on Health, Intervention, and Policy, 2006 Hillside Rd., Unit 1248, Storrs, CT 06269-1101, USA.
| | - Denise Fernandes
- University of Connecticut, Institute for Collaboration on Health, Intervention, and Policy, 2006 Hillside Rd., Unit 1248, Storrs, CT 06269-1101, USA.
| | - Amy A Gorin
- University of Connecticut, Department of Psychological Sciences, Bousfield Psychology Building, 406 Babbidge Rd, Unit 1020, Storrs, CT 06269-1101, USA.
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15
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Powers TA, Koestner R, Denes A, Cornelius T, Gorin AA. Autonomy support in a couples weight loss trial: Helping yourself while helping others. Fam Syst Health 2022; 40:70-78. [PMID: 34855419 PMCID: PMC9380832 DOI: 10.1037/fsh0000663] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Self-determination theory proposes that autonomy-supportive environments produce better health outcomes, and evidence demonstrating the importance of autonomy support for health behavior change has become increasingly clear. The bulk of the previous research has focused on the effects of receiving autonomy support, whereas the present study focuses on the potential impact of providing autonomy support for improving the weight loss and relationship satisfaction of the support provider. METHOD Sixty-four couples were randomized to a standard weight loss intervention or to an intervention that included training to enhance autonomy support behavior (e.g., empathic responding, accepting personal choices, etc.). Groups met weekly for 6 months, with assessments at baseline, 3, 6, and 12 months. The assessment of provided autonomy support was based on ratings of videotaped interactions of the couple discussing weight loss issues and on partner report of the autonomy support they received. RESULTS The results did not show any condition effects; however, the results for both conditions indicated that beyond receiving autonomy support, providing autonomy support was associated with greater sustained weight loss for the support provider, and for men greater relationship satisfaction over time. DISCUSSION The results confirm the importance of couples-based interventions and autonomy support for behavior change. In addition, it appears that providing autonomy support is useful for both the recipient and the provider. These results point to the need for developing targeted interventions to facilitate the provision of autonomy support. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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16
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Slotman B, Stinchcomb DG, Powell-Wiley TM, Ostendorf DM, Saelens BE, Gorin AA, Zenk SN, Berrigan D. Environmental data and methods from the Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) core measures environmental working group. Data Brief 2022; 41:108002. [PMID: 35300389 PMCID: PMC8920874 DOI: 10.1016/j.dib.2022.108002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/23/2022] [Accepted: 02/23/2022] [Indexed: 10/26/2022] Open
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Aschbrenner KA, Naslund JA, Gorin AA, Mueser KT, Browne J, Wolfe RS, Xie H, Bartels SJ. Group Lifestyle Intervention With Mobile Health for Young Adults With Serious Mental Illness: A Randomized Controlled Trial. Psychiatr Serv 2022; 73:141-148. [PMID: 34189933 DOI: 10.1176/appi.ps.202100047] [Citation(s) in RCA: 6] [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: 11/30/2022]
Abstract
OBJECTIVE Evidence-based lifestyle interventions tailored to young adults with serious mental illness are needed to reduce their cardiometabolic risk. This study evaluated the effectiveness of a group lifestyle intervention ("PeerFIT") enhanced with mobile health (mHealth) compared with one-on-one mHealth coaching (basic education supported by activity tracking [BEAT]) for young adults with serious mental illness who were overweight or obese. METHODS Participants were young adults ages 18-35 years with serious mental illness and a body mass index ≥25 kg/m2, who were randomly assigned to PeerFIT or BEAT. Research staff collected data at baseline and at 6 and 12 months. Main outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of >50 m on the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement). RESULTS Participants were 150 young adults with a mean ± SD body mass index of 37.1±7.4. Intent-to-treat analyses revealed no significant between-group difference for weight-loss, CRF, or CVD outcomes at 6 and 12 months. Participants in both conditions achieved clinically significant CVD risk reduction, weight loss, and CRF from baseline to 6 and 12 months, and all these improvements were statistically significant (p<0.01). CONCLUSION The PeerFIT group lifestyle intervention was not superior to one-on-one mHealth coaching in achieving clinically significant changes in weight, CRF, and CVD risk reduction. Although both interventions improved outcomes, low-intensity mHealth coaching may be a more scalable approach for addressing modifiable cardiometabolic risk factors among young adults with serious mental illness.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - John A Naslund
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Amy A Gorin
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Kim T Mueser
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Julia Browne
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Rosemarie S Wolfe
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Haiyi Xie
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Stephen J Bartels
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
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18
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Hayes JF, Tate DF, Espeland MA, LaRose JG, Gorin AA, Lewis CE, Jelalian E, Bahnson J, Wing RR. Patterns of weight change in a weight gain prevention study for young adults. Obesity (Silver Spring) 2021; 29:1848-1856. [PMID: 34549535 PMCID: PMC8570998 DOI: 10.1002/oby.23268] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Recovery from weight regain is uncommon during weight loss treatment. This study examined whether participants in a weight gain prevention intervention similarly struggle to recover following weight gains and which factors predict transitions. METHODS This is a secondary analysis of data from the Study of Novel Approaches to Weight Gain Prevention (SNAP), a randomized controlled trial comparing two weight gain prevention interventions with a control group. Young adults (n = 599; age 18-35 years) were followed over 3 years. Markov models identified transition rates in going above and returning below baseline weight across follow-up. Logistic regressions identified predictors of transitions. RESULTS At each time point, approximately double the number of participants who transitioned from below to above baseline transitioned from above to below. The magnitude of weight changes from baseline and the number of weight loss strategies used predicted transitions from below to above and above to below baseline weight (with opposite relationships). Infrequent self-weighing and lower dietary restraint predicted transitions below to above baseline weight. Treatment arm, demographics, calorie consumption, and physical activity generally did not predict transitions. CONCLUSIONS Young adults engaging in weight gain prevention struggle to lose gained weight. Alternative strategies are needed to address weight gains in weight gain prevention interventions.
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Affiliation(s)
- Jacqueline F. Hayes
- Alpert Medical School of Brown University, Miriam Hospital, Providence, Rhode Island
| | - Deborah F. Tate
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
| | - Mark A. Espeland
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine Richmond
| | - Amy A. Gorin
- Department of Psychological Sciences, University of Connecticut, Storrs
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Elissa Jelalian
- Alpert Medical School of Brown University, Miriam Hospital, Providence, Rhode Island
| | - Judy Bahnson
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
| | - Rena R. Wing
- Alpert Medical School of Brown University, Miriam Hospital, Providence, Rhode Island
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19
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Hayes JF, Russell GB, Tate DF, Espeland MA, LaRose JG, Gorin AA, Lewis CE, Jelalian E, Bahnson J, Wing RR. Who loses weight in a weight gain prevention program? A comparison of weight losers and weight maintainers at 3 years. Health Psychol 2021; 40:523-533. [PMID: 34323575 DOI: 10.1037/hea0001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Despite weight loss challenges in young adulthood, 17% of participants in the Study of Novel Approaches to Weight Gain Prevention (SNAP) weight gain prevention study lost ≥ 5% of their body weight at 3 years. These "weight losers" (n = 88) were compared to "weight maintainers" (n = 143), who successfully prevented weight gains by staying within ± 2.5% of their baseline weight at 3 years. METHOD Weight losers and maintainers (n = 231; 18-35 years old) were drawn from the SNAP randomized controlled trial (n = 599), which compared two weight gain prevention interventions with a control group. Participants completed anthropometric and psychosocial assessments at baseline, 4 months (end of face-to-face intervention), and 1, 2, and 3 years. RESULTS Three-year weight losers had significantly greater weight losses than maintainers by 4 months, and weight trajectories continued to diverge. Three-year weight change group was not associated with treatment assignment. At pretreatment, weight losers were heavier, closer to their self-reported highest ever weight, and further away from their self-identified ideal weight. Across treatment, weight losers had greater dietary restraint and autonomous motivation, had lower disinhibition and self-identified ideal weight, and self-weighed more frequently than weight maintainers. CONCLUSIONS Weight gain prevention messaging may be sufficient to initiate weight loss in a subset of young adults who are heavier and closer to their highest weight at baseline. Psychological and behavioral characteristics more consistent with weight loss may explain differences in weight outcomes between losers and maintainers at 3 years. Future studies may consider the effects of weight gain prevention versus weight loss messaging in tailoring weight control interventions for young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Hayes JF, Tate DF, Espeland MA, LaRose JG, Gorin AA, Lewis CE, Jelalian E, Bahnson J, Dunsiger SI, Wing RR. Making large changes or small changes to prevent weight gain in young adulthood: which is preferred and by whom? Transl Behav Med 2021; 11:2081-2090. [PMID: 34293164 DOI: 10.1093/tbm/ibab099] [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] [Indexed: 11/14/2022] Open
Abstract
Knowledge of participant treatment preferences can inform decision-making regarding treatment dissemination and future participant adoption. To compare participant perceptions of two evidence-based approaches for weight gain prevention in young adults to identify the intervention with the greatest likelihood of adoption. As part of a randomized trial (Study of Novel Approaches to Weight Gain Prevention [SNAP]; n = 599) testing weight gain prevention interventions in young adults (18-35 years), individuals assigned to self-regulation interventions using either large changes or small changes reported on perceived personal effectiveness and difficulty of treatment over 3 years. Treatment satisfaction at 2-year follow-up was also reported. Pre-randomization, participants believed the large change intervention would be more personally effective than the small change intervention, although they also considered it more complex. Older age, lower body mass index (p = 0.056), and desire to maintain versus lose weight predicted greater perceived effectiveness of the small change relative to large change intervention. Over follow-up, the large change intervention was no longer perceived as more effective, but perceived effectiveness aligned with assigned treatment. The small change intervention was rated as less complex than the large change intervention at 4 months, but not at other follow-ups. At study conclusion, participants were largely satisfied with both treatments; however, in the small change intervention, individuals who were not successful at preventing weight gain were less satisfied than individuals who were successful. The large and small change interventions are both appropriate for dissemination with no clear advantages based on the participant perceptions.
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Affiliation(s)
- Jacqueline F Hayes
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI 02903, USA
| | - Deborah F Tate
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA
| | - Mark A Espeland
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine Richmond, Richmond, VA 23219, USA
| | - Amy A Gorin
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Elissa Jelalian
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI 02903, USA
| | - Judy Bahnson
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA
| | - Shira I Dunsiger
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI 02912, USA
| | - Rena R Wing
- Alpert Medical School of Brown University, Miriam Hospital, Providence, RI 02903, USA
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Braun TD, Gorin AA, Puhl RM, Stone A, Quinn DM, Ferrand J, Abrantes AM, Unick J, Tishler D, Papasavas P. Shame and Self-compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery. Obes Surg 2021; 31:3177-3187. [PMID: 33905070 DOI: 10.1007/s11695-021-05392-z] [Citation(s) in RCA: 5] [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] [Received: 11/30/2020] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotional eating in bariatric surgery patients is inconsistently linked with poor post-operative weight loss and eating behaviors, and much research to date is atheoretical. To examine theory-informed correlates of pre-operative emotional eating, the present cross-sectional analysis examined paths through which experienced weight bias and internalized weight bias (IWB) may associate with emotional eating among individuals seeking bariatric surgery. METHODS We examined associations of experienced weight bias, IWB, shame, self-compassion, and emotional eating in patients from a surgical weight loss clinic (N = 229, 82.1% female, M. BMI: 48 ± 9). Participants completed a survey of validated self-report measures that were linked to BMI from the patient medical record. Multiple regression models tested associations between study constructs while PROCESS bootstrapping estimates tested the following hypothesized mediation model: IWB ➔ internalized shame ➔ self-compassion ➔ emotional eating. Primary analyses controlled for adverse childhood experiences (ACE), a common confound in weight bias research. Secondary analyses controlled for depressive/anxiety symptoms from the patient medical record (n = 196). RESULTS After covariates and ACE, each construct accounted for significant unique variance in emotional eating. However, experienced weight bias was no longer significant and internalized shame marginal, after controlling for depressive/anxiety symptoms. In a mediation model, IWB was linked to greater emotional eating through heightened internalized shame and low self-compassion, including after controlling for depressive/anxiety symptoms. CONCLUSIONS Pre-bariatric surgery, IWB may signal risk of emotional eating, with potential implications for post-operative trajectories. Self-compassion may be a useful treatment target to reduce IWB, internalized shame, and related emotional eating in bariatric surgery patients. Further longitudinal research is needed.
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Affiliation(s)
- Tosca D Braun
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA. .,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. .,Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA.
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, CT, USA
| | - Andrea Stone
- Surgical Weight Loss Center, Hartford Hospital, Glastonbury, USA
| | - Diane M Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA
| | - Jennifer Ferrand
- Institute of Living, Div. of Health Psychology, Hartford Hospital, Hartford, CT, USA
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Behavioral Medicine and Addiction Research, Butler Hospital, Providence, RI, USA
| | - Jessica Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Hospital, Glastonbury, USA
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Hospital, Glastonbury, USA
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22
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Wing RR, Espeland MA, Tate DF, Perdue LH, Bahnson J, Polzien K, Robichaud EF, LaRose JG, Gorin AA, Lewis CE, Jelalian E. Changes in Cardiovascular Risk Factors Over 6 Years in Young Adults in a Randomized Trial of Weight Gain Prevention. Obesity (Silver Spring) 2020; 28:2323-2330. [PMID: 33230964 PMCID: PMC7687606 DOI: 10.1002/oby.23003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to determine the impact of weight gain prevention interventions on changes in cardiovascular risk factors over 6 years. METHODS The Study of Novel Approaches to Weight Gain Prevention (SNAP) randomized 599 participants (ages 18-35; 46% with BMI 21-25; 54% with BMI 25-30) to Large Changes (produce buffer by losing 5-10 pounds initially), Small Changes (daily small changes in intake and activity) or Control and followed 355 participants with ongoing intervention and assessments through 6 years. RESULTS There were no significant differences among interventions for changes in weight or cardiovascular disease (CVD) risk factors from baseline to 6 years. However, 44% of participants gained ≥5%, and only 14% lost ≥5% over 6 years. Weight changes, from baseline to year 6, were significantly associated with changes in risk factors, especially insulin and high-density lipoprotein cholesterol. Earlier weight changes (e.g., weight cycling) had no beneficial or adverse effect on changes in CVD risk factors at 6 years, independent of 6-year weight changes. CONCLUSIONS Despite participation in a weight gain prevention trial, almost half of these young adults gained ≥5% or more over 6 years, with significant worsening in CVD risk factors. Greater attention to long-term weight gain prevention in young adults is needed.
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Affiliation(s)
- Rena R. Wing
- Alpert Medical School of Brown University, Miriam Hospital, Weight Control and Diabetes Research Center, Providence, Rhode Island
| | | | - Deborah F. Tate
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
| | | | - Judy Bahnson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristen Polzien
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
| | - Erica Ferguson Robichaud
- Alpert Medical School of Brown University, Miriam Hospital, Weight Control and Diabetes Research Center, Providence, Rhode Island
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine Richmond
| | - Amy A. Gorin
- Department of Psychological Sciences, University of Connecticut, Storrs
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Elissa Jelalian
- Alpert Medical School of Brown University, Miriam Hospital, Weight Control and Diabetes Research Center, Providence, Rhode Island
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23
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Braun TD, Quinn DM, Stone A, Gorin AA, Ferrand J, Puhl RM, Sierra J, Tishler D, Papasavas P. Weight Bias, Shame, and Self-Compassion: Risk/Protective Mechanisms of Depression and Anxiety in Prebariatic Surgery Patients. Obesity (Silver Spring) 2020; 28:1974-1983. [PMID: 32808737 PMCID: PMC8650800 DOI: 10.1002/oby.22920] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Psychopathology in bariatric surgery patients may contribute to adverse postoperative sequelae, including weight regain, substance use, and self-harm. This cross-sectional study aimed to advance the understanding of the risk and protective paths through which weight bias associates with depressive and anxiety symptoms in bariatric surgery candidates (BSC). METHODS BSC recruited from a surgical clinic (N = 213, 82.2% women, 43 [SD 12] years, mean BMI: 49 [SD 9] kg/m2 ) completed measures of experienced weight bias (EWB), internalized weight bias (IWB), body and internalized shame, and self-compassion; anxiety and depression screeners were accessed from medical charts. Multiple regression and PROCESS bootstrapping estimates tested our hypothesized mediation model as follows: EWB→IWB→body shame→shame→self-compassion→symptoms. RESULTS After accounting for EWB and IWB, internalized shame accounted for greater variance in both end points than body shame. EWB was associated with greater anxiety through risk paths implicating IWB, body shame, and/or internalized shame. Protective paths associated EWB with fewer depressive and anxiety symptoms among those with higher self-compassion. CONCLUSIONS The findings suggest a potentially important role for weight bias and shame in psychological health among BSC and implicate self-compassion, a trainable affect-regulation strategy, as a protective factor that may confer some resiliency. Future research using longitudinal and causal designs is warranted.
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Affiliation(s)
- Tosca D Braun
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert Medical School of Medicine, Brown University, Providence, Rhode Island, USA
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Diane M Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Andrea Stone
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Jennifer Ferrand
- Institute of Living, Division of Health Psychology, Hartford Hospital, Hartford, Connecticut, USA
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, Connecticut, USA
| | - Jessica Sierra
- Institute of Living, Division of Health Psychology, Hartford Hospital, Hartford, Connecticut, USA
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
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24
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Leahey TM, Gorin AA, Wyckoff E, Denmat Z, O'Connor K, Field C, Dunton GF, Gunstad J, Huedo-Medina TB, Gilder C. Episodic future thinking, delay discounting, and exercise during weight loss maintenance: The PACE trial. Health Psychol 2020; 39:796-805. [PMID: 32833481 DOI: 10.1037/hea0000860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Weight loss maintenance (WLM) is the next major challenge in obesity treatment. While most individuals who lose weight intend to keep their weight off, weight regain is common. Temporal Self-Regulation Theory posits that whether intentions lead to behavior depends on self-regulatory capacity, including delay discounting (DD; the tendency to discount a larger future reward in favor of a smaller immediate reward). Episodic Future Thinking (EFT; mental imagery of a future event for which a health goal is important) may improve DD and promote behavior change. Described herein is a trial protocol designed to examine whether EFT improves DD within the context of weight loss maintenance. METHOD Participants who lose ≥5% of initial body weight in an online behavioral weight loss intervention will be randomly assigned to a standard weight loss maintenance program (WLM-STD) or a weight loss maintenance program plus EFT (WLM + EFT). Both interventions involve periodic phone and in-person treatment sessions. Participants in WLM + EFT will engage in daily EFT training via smartphone. To control for contact, participants in WLM-STD will engage in daily Healthy Thinking (reviewing strategies for weight management) on their smartphone. Our primary hypothesis is that WLM + EFT will yield better improvements in DD compared to WLM-STD. We will also explore whether DD mediates the relationship between intervention allocation and physical activity (secondary outcome). Weight and contextual variables will be explored. CONCLUSIONS This study is the first to test whether EFT improves DD within the context of weight loss maintenance; results from this experimental medicine approach could have important implications for understanding the impact of both EFT and DD on sustained behavior change. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Tricia M Leahey
- Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut
| | - Amy A Gorin
- Institute for Collaboration on Health, Intervention, and Policy, Department of Psychological Sciences, University of Connecticut
| | - Emily Wyckoff
- Institute for Collaboration on Health, Intervention, and Policy, Department of Psychological Sciences, University of Connecticut
| | - Zeely Denmat
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - Kayla O'Connor
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | - Christiana Field
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | | | - John Gunstad
- Department of Psychological Sciences, Kent State University
| | - Tania B Huedo-Medina
- Institute for Collaboration on Health, Intervention, and Policy, and Department of Allied Health Sciences, University of Connecticut
| | - Carnisha Gilder
- Institute for Collaboration on Health, Intervention, and Policy, and Department of Allied Health Sciences, University of Connecticut
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25
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LaRose JG, Gorin AA, Fava JL, Bean MK, Lanoye A, Robinson E, Carey K. Using motivational interviewing to enhance emerging adults' engagement in weight loss: The Live Well RVA pilot randomized clinical trial. Obes Sci Pract 2020; 6:460-472. [PMID: 33082988 PMCID: PMC7556426 DOI: 10.1002/osp4.435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/01/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 11/15/2022] Open
Abstract
Background Emerging adults (ages 18–25) are at high risk for overweight/obesity, yet traditional adult behavioural weight loss (BWL) interventions do not meet the needs of individuals at this developmental stage. Motivational interviewing (MI) is an evidence‐based approach to promote behaviour change but has not been tested for weight loss in this population. The study aimed to test the feasibility and preliminary efficacy of an MI‐enhanced weight loss programme to promote engagement, retention and weight loss in emerging adults. Methods Emerging adults with overweight/obesity (N = 47, 81% female, 47% racial/ethnic minority, body mass index [BMI] = 33.2 ± 4.6 kg/m2) were randomized to either standard BWL or MI‐enhanced BWL (MIBWL). Weight was assessed objectively at baseline and posttreatment (3 months). Engagement (in‐person session attendance [weeks 1 and 2], online self‐monitoring [weeks 3–12] and online content viewing [weeks 3–12]) was tracked throughout the program. Results Though results did not reach the level of statistical significance, participants in MIBWL demonstrated greater programme engagement (77% vs. 61.0%, p = .11; Cohen d = .48), retention (71% vs. 48.0%, p = .10; Cohen h = .47) and intent‐to‐treat weight loss (−3.3% vs. −2.2%, p = .37; Cohen d = .26) compared with those in BWL. Conclusions Effect sizes suggest that MI might be a viable approach to enhance engagement and retention in weight loss programmes targeting emerging adults. This finding is meaningful, given the documented challenges with engagement and retention in this vulnerable population and the relationship between engagement and better weight loss outcomes. The results of this small pilot study support efforts to replicate these findings within the context of a fully powered trial.
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Affiliation(s)
- Jessica Gokee LaRose
- Department of Health Behavior and Policy Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Amy A Gorin
- Department of Psychological Sciences University of Connecticut Mansfield Connecticut USA.,Institute for Collaboration on Health, Intervention, and Policy University of Connecticut Mansfield Connecticut USA
| | - Joseph L Fava
- Weight Control and Diabetes Research Center The Miriam Hospital Providence Rhode Island USA
| | - Melanie K Bean
- Department of Pediatrics Children's Hospital of Richmond at Virginia Commonwealth University Richmond Virginia USA
| | - Autumn Lanoye
- Department of Health Behavior and Policy Virginia Commonwealth University School of Medicine Richmond Virginia USA
| | - Elizabeth Robinson
- Department of Pediatrics Children's Hospital of Richmond at Virginia Commonwealth University Richmond Virginia USA.,Summit Emotional Health Richmond Virginia USA
| | - Kate Carey
- Department of Behavioral and Social Sciences Brown University School of Public Health Providence Rhode Island USA
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26
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Wing RR, Russell GB, Tate DF, Espeland MA, LaRose JG, Gorin AA, Lewis CE, Jelalian E, Perdue LH, Bahnson J, Polzien K, Robichaud EF. Examining Heterogeneity of Outcomes in a Weight Gain Prevention Program for Young Adults. Obesity (Silver Spring) 2020; 28:521-528. [PMID: 32030910 PMCID: PMC7042032 DOI: 10.1002/oby.22720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/23/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to characterize young adults who experienced significant weight gains (> 10%) over 3 years in a weight gain prevention program. METHODS Secondary data analysis from the Study of Novel Approaches to Weight Gain Prevention (SNAP), a randomized trial comparing two self-regulation interventions and a control arm in young adults (18-35 years; BMI 21-30.9 kg/m2 ), was used. Large Gainers (≥ 10% of their body weight; n = 48), Small Gainers (2.6%-9.9%; n = 149), and Weight Stable participants (± 2.5%; n = 143) were compared on dimensions affecting weight gain. RESULTS Differences in weight gain among the three groups were significant by year 1 and subsequently increased. Those who became Large Gainers were heavier at baseline and further below their highest weight, and they reported more weight cycling than Weight Stable, with Small Gainers intermediate. Neither study arm nor pregnancy explained weight change differences among the three groups. Large Gainers reported more depressive symptoms than Weight Stable at years 1 and 2. Large Gainers were less likely to weigh themselves at least weekly at 4 months, before differences in weight gain emerged, and at years 1 and 2. CONCLUSIONS Large Gainers (representing almost 10% of participants) could be identified early by greater weight issues at baseline and lower use of weight gain prevention strategies.
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Affiliation(s)
- Rena R. Wing
- Alpert Medical School of Brown University, Miriam Hospital, Providence, Rhode Island
| | | | - Deborah F. Tate
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
| | | | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine Richmond
| | - Amy A. Gorin
- Department of Psychological Sciences, University of Connecticut, Storrs
| | - Cora E. Lewis
- Department of Medicine, University of Alabama at Birmingham, Birmingham
| | - Elissa Jelalian
- Alpert Medical School of Brown University, Miriam Hospital, Providence, Rhode Island
| | | | - Judy Bahnson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristen Polzien
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
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27
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Gorin AA, Powers TA, Gettens K, Cornelius T, Koestner R, Mobley AR, Pescatello LS, Huedo-Medina TB. A randomized controlled trial of a theory-based weight-loss program for couples. Health Psychol 2020; 39:137-146. [PMID: 31789558 PMCID: PMC6957719 DOI: 10.1037/hea0000808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/22/2023]
Abstract
OBJECTIVE Weight gain occurs during marriage, yet obesity treatment is focused on individuals. Outcomes may be improved by targeting joint weight loss and the interpersonal milieu that fosters spousal interdependence. Self-determination theory (SDT) posits that autonomy-supportive environments (e.g., promote meaningful choice, minimize control) produce better health outcomes. This trial tested an SDT-informed weight-loss intervention intended to facilitate autonomy support in couples. METHOD Sixty-four couples were randomized to standard behavioral weight loss (BWL) that couples attended together or to a SDT-informed weight-loss intervention (SDT-WL) that aimed to bolster autonomy support (AS). Groups met weekly for 6 months with assessments at 0, 3, 6, and 12 months. RESULTS Percent weight loss at 6 and 12 months was 10.4% ± 6.5% and 9.2% ± 8.2%. No differences were observed between the BWL and SDT-WL conditions in percent weight loss or changes in AS. Across conditions, higher baseline AS predicted greater weight loss at 6 and 12 months (ps <.001). Increases in AS over time predicted greater weight loss at 6 and 12 months (ps ≤ .02). Post hoc moderation analysis indicated that only participants with low (but not high) baseline AS achieved greater gains in AS at 12 months in SDT-WL than in the BWL conditions (p < .02). CONCLUSIONS Although no differences were found between conditions on weight loss or changes in autonomy support behavior, autonomy support from one's spouse predicted weight loss in both couples-based weight-loss approaches. For couples with low levels of AS, an SDT-informed approach was effective at increasing this desirable interpersonal behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut
| | | | - Katelyn Gettens
- Department of Psychological Sciences, University of Connecticut
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center
| | | | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida
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28
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Wing RR, Espeland MA, Tate DF, Perdue LH, Bahnson J, Polzien K, Robichaud EF, LaRose JG, Gorin AA, Lewis CE, Jelalian E. Weight Gain Over 6 Years in Young Adults: The Study of Novel Approaches to Weight Gain Prevention Randomized Trial. Obesity (Silver Spring) 2020; 28:80-88. [PMID: 31858732 PMCID: PMC6927481 DOI: 10.1002/oby.22661] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/21/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The study objective was to determine whether two self-regulation interventions that reduced 3-year weight gain in young adults remain effective at 6 years. METHODS A randomized trial was conducted in two academic settings in 599 young adults, aged 18 to 35 years, with normal weight or overweight; 504 (84%) reconsented for a 6-year extension (Study of Novel Approaches to Weight Gain Prevention-Extended [SNAP-E]) with ongoing intervention and assessments. Weight gain over 6 years was compared for all assigned to Control, Large Changes (LC; lose 5-10 pounds initially), and Small Changes (SC; make small daily changes in intake and activity). RESULTS Weight change from baseline to 6 years did not differ significantly among the three groups (Control = 3.9 kg, SC = 4.1 kg, and LC = 2.8 kg). However, there was a significant age-by-treatment interaction (P = 0.002). Among those < 25 years old, weight gain from baseline to 6 years averaged 7.3 kg in the Control group and was reduced by almost 50% in LC and SC. LC also significantly reduced mean weight gain (area under the curve) over 6 years compared with Control or SC. CONCLUSIONS Although the interventions did not reduce weight gain at 6 years for the full cohort, they were effective in those < 25 years old. Future efforts should focus on young adults aged 18 to 24.9 and test more intensive interventions with more diverse participants.
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Affiliation(s)
- Rena R. Wing
- Alpert Medical School of Brown University, Miriam Hospital, Providence, Rhode Island
| | | | - Deborah F. Tate
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
| | | | - Judy Bahnson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristen Polzien
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
| | | | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine Richmond
| | - Amy A. Gorin
- Department of Psychological Sciences, University of Connecticut, Storrs
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Elissa Jelalian
- Alpert Medical School of Brown University, Miriam Hospital, Providence, Rhode Island
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29
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Hagobian TA, Phelan S, Schaffner A, Brannen A, McHugh A, Ashby-Thompson M, Gorin AA, Pi-Sunyer X, Gallagher D, Wing R. Ripple Effect of Lifestyle Interventions During Pregnancy on Untreated Partners' Weight. Obesity (Silver Spring) 2019; 27:733-739. [PMID: 30957985 PMCID: PMC6478509 DOI: 10.1002/oby.22447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/19/2018] [Accepted: 01/23/2019] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Weight-loss interventions have a positive "ripple effect" on untreated partners' weight, but ripple effects in pregnancy are unknown. The objective of this study was to determine whether prenatal lifestyle interventions that reduce gestational weight gain in pregnant women have a positive ripple effect on untreated partners' weight. METHODS Two clinical trials with the same outcome measures randomly assigned pregnant women to a lifestyle intervention or usual care. Untreated partners were randomly assigned according to their pregnant partner's group allocation and were assessed at study entry (~13 weeks' gestation), 35 weeks' gestation, and 6 and 12 months after delivery. RESULTS A total of 122 partners (100% male, 23% Hispanic, 82% married, and 48% with obesity) were randomly assigned to the intervention (n = 59) or usual care (n = 63). There was no intervention or intervention-by-time interaction effect on partner weight (P = 0.795). Partner weight changes were not statistically significant (P = 0.120) from study entry to 35 weeks' gestation (mean 0.19 kg; 95% CI: -0.73 to 1.24) or to 12 months after delivery (mean 0.82 kg; 95% CI: -0.26 to 1.91). CONCLUSIONS There was no evidence of a ripple effect on partner weight. In a self-selected sample, partners of pregnant women appeared not to experience sympathy weight gain.
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Affiliation(s)
- Todd A Hagobian
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Suzanne Phelan
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Andrew Schaffner
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
- Department of Statistics, California Polytechnic State University, San Luis Obispo, California, USA
| | - Anna Brannen
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Angelica McHugh
- Department of Psychiatry, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Maxine Ashby-Thompson
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Xavier Pi-Sunyer
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Dympna Gallagher
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Rena Wing
- Department of Psychiatry, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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30
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LaRose JG, Neiberg RH, Evans EW, Tate DF, Espeland MA, Gorin AA, Perdue L, Hatley K, Lewis CE, Robichaud E, Wing RR. Dietary outcomes within the study of novel approaches to weight gain prevention (SNAP) randomized controlled trial. Int J Behav Nutr Phys Act 2019; 16:14. [PMID: 30704533 PMCID: PMC6357348 DOI: 10.1186/s12966-019-0771-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/26/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young adults (YA) are at high-risk for unhealthy dietary behaviors and weight gain. The Study of Novel Approaches to Weight Gain Prevention (SNAP) Trial demonstrated that two self-regulation approaches were effective in reducing weight gain over 2 years compared with control. The goal of this analysis was to examine effects of intervention on dietary outcomes and the association of diet changes with weight change. METHODS Participants were 599 YA, age 18-35 years, BMI 21.0-30.0 kg/m2 (27.4 ± 4.4 years; 25.4 ± 2.6 kg/m2; 22% men; 73% non-Hispanic White), who were recruited in Providence, RI and Chapel Hill, NC and randomized to self-regulation with Small Changes (SC), self-regulation with Large Changes (LC) or Control (C). SC and LC emphasized frequent self-weighing to cue behavior changes (small daily changes vs. periodic large changes) and targeted high-risk dietary behaviors. Diet and weight were assessed at baseline, 4 months and 2 years. RESULTS LC and SC had greater decreases in energy intake than C at 4 months but not 2 years. LC had the greatest changes in percent calories from fat at 4 months, but differences were attenuated at 2 years. No differences in diet quality were observed. Across conditions, increased total energy consumption, fast food, meals away from home, and binge drinking, and decreased dietary quality and breakfast consumption were all associated with weight gain at 2 years. CONCLUSIONS This study suggests the need to strengthen interventions to produce longer term changes in dietary intake and helps to identify specific behaviors associated with weight gain over time in young adults. TRIAL REGISTRATION Clinicaltrials.gov # NCT01183689 , registered August 18, 2010.
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Affiliation(s)
- Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 E. Main St, 4th Floor, Richmond, VA, 23219, USA.
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - E Whitney Evans
- Weight Control and Diabetes Research Center at The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Deborah F Tate
- Lineberger Cancer Center and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amy A Gorin
- University of Connecticut, Institute for Collaboration on Health, Intervention, and Policy, Storrs, CT, USA
| | - Letitia Perdue
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Karen Hatley
- Lineberger Cancer Center and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erica Robichaud
- Weight Control and Diabetes Research Center at The Miriam Hospital, Providence, RI, USA
| | - Rena R Wing
- Weight Control and Diabetes Research Center at The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Gorin AA, Gokee LaRose J, Espeland MA, Tate DF, Jelalian E, Robichaud E, Coward P, Hatley KE, Garcia KR, Lang W, Bahnson J, Lewis CE, Wing RR. Eating pathology and psychological outcomes in young adults in self-regulation interventions using daily self-weighing. Health Psychol 2018; 38:143-150. [PMID: 30550313 DOI: 10.1037/hea0000689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Self-regulation interventions encouraging daily weighing prevent weight gain in young adults; however, concerns have been raised that such interventions may have undesirable effects on eating pathology, depression, and health-related quality of life (HRQL). The present study examined whether self-regulation interventions and self-weighing frequency were associated with these indices in normal weight individuals and those with overweight or obesity. METHODS Young adults (n = 599), 18-35 years with a body mass index (BMI) 21.0-30.9 kg/m² were randomized to control, self-regulation with small changes (SC) or self-regulation with large changes (LC). Interventions taught frequent self-weighing to guide behavioral changes. SC prescribed daily small decreases in intake and increases in physical activity. LC prescribed a 5- to 10-lb weight loss to buffer against anticipated gains. Psychological indices were assessed at baseline and periodically over 2 years of follow-up. RESULTS There was no evidence that the interventions increased depressive symptoms or compensatory behaviors or decreased HRQL relative to control. LC increased flexible and rigid control and SC decreased disinhibition. Results did not differ by weight status with the exception of rigid control; here, differences between LC and the other conditions were smaller among those with BMI ≥ 25. Greater self-weighing frequency over time was associated with increases in flexible and rigid control, dietary restraint, and improvements in HRQL. CONCLUSIONS The self-regulation interventions and increases in self-weighing had no untoward effects. Encouraging weight gain prevention in young adults through frequent weighing and self-regulation appears to be safe for normal weight young adults and those with overweight. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Amy A Gorin
- Institute for Collaboration on Health, Intervention, and Policy
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Cloutier MM, Wiley JF, Kuo CL, Cornelius T, Wang Z, Gorin AA. Outcomes of an early childhood obesity prevention program in a low-income community: a pilot, randomized trial. Pediatr Obes 2018; 13:677-685. [PMID: 30156058 PMCID: PMC7982990 DOI: 10.1111/ijpo.12458] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/04/2018] [Accepted: 06/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity is a major and worldwide health problem in children. OBJECTIVES The Early Childhood Obesity Prevention Program is a multi-component, randomized, controlled trial of a pilot community-focused obesity prevention program for mother/newborn dyads. METHODS Underserved, mother/newborn dyads were recruited to receive a standard home visitation program (Nurturing Families Network, NFN) or an enhanced program (NFN+) that incorporated behavioural change strategies (e.g., goal-setting, problem-solving) and focused on six obesity-associated behaviours (breastfeeding, juice/sugar-sweetened beverages, solids, infant sleep, TV/screen time and soothability) with linkages to community resources. Weight-for-length (WFL) z-score and maternal diet were secondary outcomes. RESULTS Fifty-seven dyads were recruited and 47 fully eligible dyads were enrolled (NFN = 21, NFN+ = 26). Forty-one (87.2%) were assessed at 6 months and 34 (72.3%) at 12 months. Retention at 12 months was higher for NFN+ dyads (84.6% vs. 56.1%, p = 0.04). NFN+ mothers were more likely to continue breastfeeding at 6 and 12 months vs. NFN mothers (p = 0.03 and 0.003, respectively), and at 12 months, NFN+ infants had fewer nocturnal awakenings (p = 0.04). There were no differences in other primary outcome measures or in WFL z-score at 6 or 12 months. CONCLUSIONS A multi-component behavioural intervention increased breastfeeding duration and decreased nocturnal awakenings in infants of low-income families.
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Affiliation(s)
- M M Cloutier
- Department of Pediatrics UCONN Health, Children's Center for Community Research Connecticut Children's Medical Center, Hartford, CT, USA
| | - J F Wiley
- DO Candidate 2019, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - C-L Kuo
- Department of Community Medicine and Health Care, Connecticut Institute for Clinical and Translational Science, Farmington, CT, USA
| | - T Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Z Wang
- Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA
| | - A A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
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Aschbrenner KA, Naslund JA, Gorin AA, Mueser KT, Scherer EA, Viron M, Kinney A, Bartels SJ. Peer support and mobile health technology targeting obesity-related cardiovascular risk in young adults with serious mental illness: Protocol for a randomized controlled trial. Contemp Clin Trials 2018; 74:97-106. [PMID: 30316998 PMCID: PMC6217796 DOI: 10.1016/j.cct.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/24/2018] [Revised: 09/29/2018] [Accepted: 10/10/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Individuals with serious mental illness (SMI) such as schizophrenia and bipolar disorder face a higher risk of early death due to cardiovascular disease and other preventable chronic illnesses. Young adulthood is a critical window of development for lifestyle interventions to improve the long-term health and quality of life in this population. Fit Forward is an NIH-funded randomized clinical trial examining the effectiveness of a group lifestyle intervention (PeerFIT) enhanced with mobile health technology compared to one-on-one mobile lifestyle coaching with Basic Education in fitness and nutrition supported by a wearable Activity Tracking device (BEAT) in achieving clinically significant weight loss and improved cardiorespiratory fitness in young adults with SMI. METHODS Fit Forward targets 144 young adults (18 to 35 years) with SMI and a body mass index (BMI) of ≥25 receiving public mental health services. In a two-arm randomized clinical trial, participants will be randomly assigned with equal probability to PeerFIT or BEAT, stratified by birth sex and psychiatric diagnosis. Participants will be assessed at baseline, 6, and 12 months. The primary outcome is cardiovascular risk reduction indicated by either clinically significant weight loss (5% or greater) or increased fitness (>50 m on the 6-Minute Walk Test). Secondary outcomes include change in BMI, lipids, and hemoglobin A1c. Perceived self-efficacy for exercise and peer support will be evaluated as mechanisms underlying intervention effects. CONCLUSION If effective, PeerFIT will provide a potentially scalable approach to addressing health risks among young adults with SMI in mental health settings. TRIALS REGISTRATION ClinicalTrials.gov, NCT02815813.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States.
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, United States
| | - Amy A Gorin
- Department of Psychology, University of Connecticut, Storrs, CT, United States
| | - Kim T Mueser
- Department of Occupational Therapy, Boston University, Boston, MA, United States
| | - Emily A Scherer
- Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Mark Viron
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Allison Kinney
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States
| | - Stephen J Bartels
- The Mongan Institute, Massachusetts General Hospital, Cambridge, MA, United States
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Gettens KM, Carbonneau N, Koestner R, Powers TA, Gorin AA. The role of partner autonomy support in motivation, well-being, and weight loss among women with higher baseline BMI. Fam Syst Health 2018; 36:347-356. [PMID: 29999341 PMCID: PMC6131030 DOI: 10.1037/fsh0000362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
INTRODUCTION The association of partner autonomy support with women's motivation for healthy eating, weight-related health behavior change, and psychological well-being has been largely overlooked. Results of 2 studies showed that the positive association between autonomy support and a variety of motivational and psychological outcomes was especially pronounced for women with high body mass index (BMI) (+1 SD) compared to low BMI (-1 SD). METHOD In Study 1, autonomy support was measured as male partners' report of their behavior in a cross-sectional design. In Study 2, autonomy support was measured as female participants' perceptions of their partners' behavior in a longitudinal home environment-based behavioral weight loss intervention. RESULTS Study 1 showed that autonomy support from partners was associated with greater self-determined motivation for healthy eating and self-reported well-being among women with higher BMI. Study 2 showed that changes in partner autonomy support over 18 months of a home-based weight loss intervention were associated with increases in motivation for treatment and greater weight loss, especially for women who had higher baseline BMI. DISCUSSION Both studies demonstrated that autonomy support was associated with adaptive functioning across weight status but that it was especially potent for women with higher BMI. This pattern of findings is explained in terms of the pressures women with higher BMI may feel about their weight-related behaviors. (PsycINFO Database Record
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Olson KL, Neiberg RH, Tate DF, Garcia KR, Gorin AA, Lewis CE, Unick J, Wing RR. Weight and Shape Concern Impacts Weight Gain Prevention in the SNAP Trial: Implications for Tailoring Intervention Delivery. Obesity (Silver Spring) 2018; 26:1270-1276. [PMID: 29956495 PMCID: PMC6437682 DOI: 10.1002/oby.22212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/20/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The Study of Novel Approaches to Weight Gain Prevention (SNAP) trial demonstrated that two self-regulatory interventions prevented weight gain in young adults. Weight and shape concern (WSC) at baseline was evaluated as a moderator of weight outcomes at 24 months. METHODS Young adults (n = 599) were randomized to self-regulation with small changes (to create 200 kcal/day deficit), self-regulation with large changes (to facilitate preemptive weight loss of 5-10 lb), or self-guided control. WSC was assessed by using one item from the Eating Disorders Assessment. ANOVA was used to examine whether the association between baseline level of WSC and percent weight change over 24 months differed across treatment conditions. RESULTS Approximately 22% of participants reported high WSC (37% moderate; 41% low). WSC and treatment condition interacted to influence weight change at 24 months (P = 0.03). Individuals with high WSC gained weight in the large changes group (WSC least squares means ± SE, high: + 0.73% ± 1.19%; moderate: -2.74% ± 0.84%; low: -2.41% ± 0.79%). The small changes condition was particularly effective for those with high WSC (high WSC: -2.49% ± 1.16%; moderate: -0.60% ± 0.88%; low: -0.71% ± 0.80%). WSC did not impact weight change among control participants. CONCLUSIONS Individuals with high WSC may benefit from a small-changes approach to weight gain prevention. These findings indicate WSC may be used to match individuals to weight gain prevention treatment conditions.
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Affiliation(s)
- KayLoni L. Olson
- Alpert Medical School of Brown University, The Miriam Hospital, Providence RI
| | - Rebecca H. Neiberg
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem NC
| | | | - Katelyn R. Garcia
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem NC
| | - Amy A. Gorin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs CT
| | - Cora E. Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham AL
| | - Jessica Unick
- Alpert Medical School of Brown University, The Miriam Hospital, Providence RI
| | - Rena R. Wing
- Alpert Medical School of Brown University, The Miriam Hospital, Providence RI
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Cornelius T, Gettens K, Lenz E, Wojtanowski AC, Foster GD, Gorin AA. How prescriptive support affects weight loss in weight-loss intervention participants and their untreated spouses. Health Psychol 2018; 37:775-781. [PMID: 29927273 DOI: 10.1037/hea0000630] [Citation(s) in RCA: 6] [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: 11/08/2022]
Abstract
OBJECTIVE Controlling or prescriptive support styles (e.g., pressure) often hinder weight loss, but can sometimes be beneficial. This secondary analysis of data from a randomized controlled trial examined persuasion, pressure, and indirect social control among cohabiting couples and the effect of these supports on weight loss. METHODS Couples (NCouples = 130) were randomized to either Weight Watchers (WW) or a self-guided control condition (SG). Only one member of each couple received the intervention; the other member of the couple was untreated. Couples were weighed and completed study measures at baseline, 3, and 6 months. RESULTS Dyadic multilevel models examined BMI change and differences across role (treated participant/untreated spouse) and condition (WW/SG). Prescriptive support predicted BMI change for treated participants in the WW condition only. For treated WW participants, there was no significant decrease in BMI when pressure was high (+1SD), B = -.25, p = .22, but a significant decrease when pressure was low (0), B = -.96, p < .001. Additionally, high levels of indirect social control (+1SD) predicted greater decreases in BMI compared to low (-1SD) indirect social control, B = -.91, p < .001, and, B = -.41, p < .01. CONCLUSIONS Considering both the type and context of support for weight management is worthwhile. Intervention participants had access to treatment resources that may have engendered more effective responses to spouses' concerns or a sense of obligation to their spouse (indirect social control), whereas pressures to lose weight-while engaged in treatment-may have undermined behavior-change efforts. (PsycINFO Database Record
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Affiliation(s)
| | | | - Erin Lenz
- Department of Psychological Sciences
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Saelens BE, Arteaga SS, Berrigan D, Ballard RM, Gorin AA, Powell-Wiley TM, Pratt C, Reedy J, Zenk SN. Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures: Environmental Domain. Obesity (Silver Spring) 2018; 26 Suppl 2:S35-S44. [PMID: 29575779 PMCID: PMC5875459 DOI: 10.1002/oby.22159] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is growing interest in how environment is related to adults' weight and activity and eating behaviors. However, little is known about whether environmental factors are related to the individual variability seen in adults' intentional weight loss or maintenance outcomes. OBJECTIVES The environmental domain subgroup of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project sought to identify a parsimonious set of objective and perceived neighborhood and social environment constructs and corresponding measures to include in the assessment of response to adult weight-loss treatment. SIGNIFICANCE Starting with the home address, the environmental domain subgroup recommended for inclusion in future weight-loss or maintenance studies constructs and measures related to walkability, perceived land use mix, food outlet accessibility (perceived and objective), perceived food availability, socioeconomics, and crime-related safety (perceived and objective) to characterize the home neighborhood environment. The subgroup also recommended constructs and measures related to social norms (perceived and objective) and perceived support to characterize an individual's social environment. The 12 neighborhood and social environment constructs and corresponding measures provide a succinct and comprehensive set to allow for more systematic examination of the impact of environment on adults' weight loss and maintenance.
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Affiliation(s)
- Brian E Saelens
- Department of Pediatrics, University of Washington, Seattle Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - S Sonia Arteaga
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - David Berrigan
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rachel M Ballard
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Tiffany M Powell-Wiley
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jill Reedy
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shannon N Zenk
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
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Gorin AA, Lenz EM, Cornelius T, Huedo‐Medina T, Wojtanowski AC, Foster GD. Randomized Controlled Trial Examining the Ripple Effect of a Nationally Available Weight Management Program on Untreated Spouses. Obesity (Silver Spring) 2018; 26:499-504. [PMID: 29388385 PMCID: PMC5838794 DOI: 10.1002/oby.22098] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE For married couples, when one spouse participates in weight loss treatment, the untreated spouse can also experience weight loss. This study examined this ripple effect in a nationally available weight management program. METHODS One hundred thirty dyads were randomized to Weight Watchers (WW; n = 65) or to a self-guided control group (SG; n = 65) and assessed at 0, 3, and 6 months. Inclusion criteria were age ≥ 25 years, BMI 27 to 40 kg/m2 (≥ 25 kg/m2 for untreated spouses), and no weight loss contraindications. WW participants received 6 months of free access to in-person meetings and online tools. SG participants received a weight loss handout. Spouses did not receive treatment. RESULTS Untreated spouses lost weight at 3 months (WW = -1.5 ± 2.9 kg; SG = -1.1 ± 3.3 kg) and 6 months (WW = -2.2 ± 4.2 kg; SG = -1.9 ± 3.6 kg), but weight losses did not differ by condition. Overall, 32.0% of untreated spouses lost ≥ 3% of initial body weight by 6 months. Baseline weight was significantly correlated within couples (r = 0.26; P < 0.01) as were weight loss trajectories (r = 0.52; P < 0.001). CONCLUSIONS Evidence of a ripple effect was found in untreated spouses in both formal and self-guided weight management approaches. These data suggest that weight loss can spread within couples, and that widely available lifestyle programs have weight loss effects beyond the treated individual.
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Affiliation(s)
- Amy A. Gorin
- Department of Psychological Sciences and the Institute for Collaboration on Health, Intervention, and PolicyUniversity of ConnecticutStorrsConnecticutUSA
| | - Erin M. Lenz
- Department of Psychological Sciences and the Institute for Collaboration on Health, Intervention, and PolicyUniversity of ConnecticutStorrsConnecticutUSA
| | - Talea Cornelius
- Department of Psychological Sciences and the Institute for Collaboration on Health, Intervention, and PolicyUniversity of ConnecticutStorrsConnecticutUSA
| | - Tania Huedo‐Medina
- Department of Allied Health SciencesUniversity of ConnecticutStorrsConnecticutUSA
| | | | - Gary D. Foster
- Weight Watchers International, Inc.New YorkNew YorkUSA
- Center for Weight and Eating DisordersUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Abstract
BACKGROUND Despite health and economic burdens associated with overweight and obesity, long-term weight loss intervention efforts have been largely unsuccessful. Observations that weight status tends to cluster in social groups, and findings showing "ripple" effects of weight change within social clusters, raise questions about the impact of social relationships on weight loss. PURPOSE Through a reanalysis of data from a randomized weight loss intervention, this study compared dyadic dynamics in intervention participants and in-home partners. METHODS Over the course of 18 months, data was collected from 201 pairs enrolled in either behavioral weight loss treatment (BWL) or treatment including partners and providing items to facilitate healthy choices at home (BWL + H). Using a dyadic growth curve model, covariance between baseline BMI, BMI change trajectories, and starting BMI and BMI trajectory for both the self and the other were examined. RESULTS There were strong indicators of dependence in the data. Baseline BMI was positively correlated for both treatment groups. In the BWL + H condition, BMI change trajectories were positively correlated. In the BWL condition, this reversed: Change trajectories were negatively correlated. Additionally, partner BMI and primary participant BMI change were positively correlated, indicating that a heavier partner at baseline related to less weight loss. CONCLUSIONS Social relationships exert a significant influence on weight loss outcomes. Depending on the intervention group, these influences may help (BWL + H) or hinder (BWL). It may be that home intervention changed social support and interaction in important ways and that these effects could be effectively harnessed to implement more effective interventions (NCT00200330).
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Affiliation(s)
- Talea Cornelius
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA.
| | - Katelyn Gettens
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Amy A Gorin
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
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Chao AM, Wadden TA, Gorin AA, Tronieri JS, Pearl RL, Bakizada ZM, Yanovski SZ, Berkowitz RI. Binge Eating and Weight Loss Outcomes in Individuals with Type 2 Diabetes: 4-Year Results from the Look AHEAD Study. Obesity (Silver Spring) 2017; 25:1830-1837. [PMID: 29086498 PMCID: PMC5678986 DOI: 10.1002/oby.21975] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 05/19/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aims to assess whether an intensive lifestyle intervention (ILI) for weight reduction precipitates binge eating (BE) and whether BE attenuates 4-year weight loss among participants with type 2 diabetes and overweight or obesity. METHODS Participants (N = 4,901) were from Look AHEAD, a randomized controlled trial that compared ILI to diabetes support and education (DSE). Annual assessments of measured weight and self-reported BE were used. By using the yearly time points when a person endorsed BE, participants were classified as no BE, remitted BE, incident BE, inconsistent BE (2-3 years, including baseline), and consistent BE (≥ 4 years, including baseline). Cox regression and mixed-effects models were used for analyses. RESULTS ILI participants were marginally more likely to report incident BE at year 4 than those in DSE (P = 0.06). At year 4, ILI participants with remitted BE lost more weight (4.7 ± 0.8%) than those with consistent BE (1.9 ± 1.0%; P = 0.03). ILI participants with no BE lost more weight (4.6 ± 0.2%) than those with incident BE (3.1 ± 0.6%; P = 0.02) and consistent BE (P = 0.01). DSE participants with remitted BE lost more weight than those with incident and consistent BE. CONCLUSIONS Preexisting BE did not seem to be a contraindication for ILI, although persistent BE attenuated weight loss. Patients who report new or ongoing BE may need additional treatment.
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Affiliation(s)
- Ariana M. Chao
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Thomas A. Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Amy A. Gorin
- University of Connecticut, Department of Psychology, Storrs, CT, USA
| | - Jena Shaw Tronieri
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Rebecca L. Pearl
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Zayna M. Bakizada
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Susan Z. Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD, USA
| | - Robert I. Berkowitz
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
- The Children’s Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Science, Philadelphia, PA, USA
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Gorin AA, Powers TA, Gettens K, Cornelius T, Koestner R, Mobley AR, Pescatello L, Medina TH. Project TEAMS (Talking about Eating, Activity, and Mutual Support): a randomized controlled trial of a theory-based weight loss program for couples. BMC Public Health 2017; 17:749. [PMID: 28962602 PMCID: PMC5622424 DOI: 10.1186/s12889-017-4732-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Obesity risk is shared between spouses, yet existing weight loss programs focus on individuals and not the marital dyad. Given the interdependence of weight in couples, weight management outcomes might be improved by targeting joint weight loss and the creation of an interpersonal milieu that supports long-term behavior change. According to Self-Determination Theory (SDT), greater autonomous self-regulation of behaviors, and subsequently better treatment outcomes, are observed in needs supportive environments in which personally meaningful choice is supported and criticism and control are minimized. Correlational analyses confirm these pathways in weight management, with needs support from one's spouse or partner emerging as a distinct predictor of weight loss success. Research is now needed to establish causal links and to develop and test weight loss interventions designed to facilitate the needs supportive behavior of spouses. METHODS Project TEAMS (Talking about Eating, Activity, and Mutual Support) is a randomized controlled trial testing a couples-based intervention, grounded in SDT, designed to change the social context of weight loss by training spouses to provide needs support for each other's eating and physical activity behavior. Sixty-four couples will be randomized to either 6 months of behavioral weight loss treatment informed by SDT (SDT-WL) or to 6 months of standard behavioral weight loss treatment (BWL). Couples will attend weekly sessions for 6 months and will be assessed at 0, 3, 6, and 12 months. By bolstering needs support, SDT-WL is predicted to increase autonomous self-regulation and perceived competence and produce greater weight loss and maintenance than standard behavioral treatment. Exploratory analyses will examine the SDT process model prediction that the influence of needs support on treatment outcomes will be mediated by autonomous self-regulation and perceived competence. DISCUSSION This study addresses the fundamental importance of interpersonal support in weight management by focusing on couples rather than individuals and using a rich theoretical framework to train spouses in supportive behaviors. TRIAL REGISTRATION Clinicaltrials.gov ; NCT02570009 .
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Affiliation(s)
- Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA.
| | - Theodore A Powers
- Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA, USA
| | - Katelyn Gettens
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | - Talea Cornelius
- Columbia University Medical Center, 622 W 168th St PH9-319, New York, NY, 10032, USA
| | | | - Amy R Mobley
- Department of Nutritional Sciences, Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, 06269, USA
| | - Linda Pescatello
- Department of Kinesiology, Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, 02669, USA
| | - Tania Huedo Medina
- Department of Allied Health Sciences, Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, 06269, USA
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Cloutier MM, Wiley JF, Trapp C, Haile J, Gorin AA. The Childcare Center: an Untapped Opportunity to Engage and Educate Families in Healthy Behaviors. J Racial Ethn Health Disparities 2017. [DOI: 10.1007/s40615-017-0386-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Butryn ML, Forman EM, Lowe MR, Gorin AA, Zhang F, Schaumberg K. Efficacy of environmental and acceptance-based enhancements to behavioral weight loss treatment: The ENACT trial. Obesity (Silver Spring) 2017; 25:866-872. [PMID: 28337847 PMCID: PMC5404972 DOI: 10.1002/oby.21813] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 10/06/2016] [Revised: 02/03/2017] [Accepted: 02/07/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study was designed to compare weight loss through a traditional behavioral treatment (BT) approach that integrated skills for managing the obesogenic food environment (BT + E) with an approach that integrated environmental and acceptance-based skills (BT + EA). Moderators were examined as an exploratory aim. METHODS Adults (N = 283) were randomly assigned to treatment condition and provided with 26 group-based sessions over the course of 12 months. Weight was measured in the clinic at months 0, 6, and 12. RESULTS Change in weight over time did not significantly differ by condition. However, race significantly moderated the effect of condition on weight loss (P = 0.04), such that African-American participants lost less weight than non-Hispanic white participants in the BT (6.2% vs. 11.5%) and BT + E conditions (6.6% vs. 12.2%), but weight loss in these two groups was similar in the BT + EA condition (9.4% vs. 11.5%). Among African Americans, rates of achieving a clinically significant weight loss (i.e., > 5%) at 12 months were higher in BT + EA (80%) than BT (57%) or BT + E (48%) (P = 0.04). CONCLUSIONS This innovative behavioral approach shows promise for treatment of African Americans, which is notable given the lack of progress to date addressing racial disparities in obesity intervention efficacy.
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Affiliation(s)
- Meghan L Butryn
- Psychology Department, Drexel University, Philadelphia, Pennsylvania, USA
| | - Evan M Forman
- Psychology Department, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michael R Lowe
- Psychology Department, Drexel University, Philadelphia, Pennsylvania, USA
| | - Amy A Gorin
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Fengqing Zhang
- Psychology Department, Drexel University, Philadelphia, Pennsylvania, USA
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Puhl RM, Himmelstein MS, Gorin AA, Suh YJ. Missing the target: including perspectives of women with overweight and obesity to inform stigma-reduction strategies. Obes Sci Pract 2017; 3:25-35. [PMID: 28392929 PMCID: PMC5358077 DOI: 10.1002/osp4.101] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 10/19/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Pervasive weight stigma and discrimination have led to ongoing calls for efforts to reduce this bias. Despite increasing research on stigma-reduction strategies, perspectives of individuals who have experienced weight stigma have rarely been included to inform this research. The present study conducted a systematic examination of women with high body weight to assess their perspectives about a broad range of strategies to reduce weight-based stigma. METHODS Women with overweight or obesity (N = 461) completed an online survey in which they evaluated the importance, feasibility and potential impact of 35 stigma-reduction strategies in diverse settings. Participants (91.5% who reported experiencing weight stigma) also completed self-report measures assessing experienced and internalized weight stigma. RESULTS Most participants assigned high importance to all stigma-reduction strategies, with school-based and healthcare approaches accruing the highest ratings. Adding weight stigma to existing anti-harassment workplace training was rated as the most impactful and feasible strategy. The family environment was viewed as an important intervention target, regardless of participants' experienced or internalized stigma. CONCLUSION These findings underscore the importance of including people with stigmatized identities in stigma-reduction research; their insights provide a necessary and valuable contribution that can inform ways to reduce weight-based inequities and prioritize such efforts.
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Affiliation(s)
- R M Puhl
- Department of Human Development & Family Studies; Rudd Center for Food Policy & Obesity University of Connecticut Hartford CT USA
| | - M S Himmelstein
- Rudd Center for Food Policy & Obesity University of Connecticut Hartford CT USA
| | - A A Gorin
- Department of Psychological Sciences University of Connecticut Storrs CT USA
| | - Y J Suh
- University of Massachusetts Medical School Worcester MA USA
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Gettens KM, Gorin AA. Executive function in weight loss and weight loss maintenance: a conceptual review and novel neuropsychological model of weight control. J Behav Med 2017; 40:687-701. [PMID: 28160229 DOI: 10.1007/s10865-017-9831-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 08/10/2016] [Accepted: 01/18/2017] [Indexed: 02/07/2023]
Abstract
Weight loss maintenance is a complex, multifaceted process that presents a significant challenge for most individuals who lose weight. A growing body of literature indicates a strong relationship between cognitive dysfunction and excessive body weight, and suggests that a subset of high-order cognitive processes known as executive functions (EF) likely play an important role in weight management. Recent reviews cover neuropsychological correlates of weight status yet fail to address the role of executive function in the central dilemma of successful weight loss maintenance. In this paper, we provide an overview of the existing literature examining executive functions as they relate to weight status and initial weight loss. Further, we propose a novel conceptual model of the relationships between EF, initial weight loss, and weight loss maintenance, mapping specific executive functions onto strategies known to be associated with both phases of the weight control process. Implications for the development of more efficacious weight loss maintenance interventions are discussed.
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Wing RR, Tate DF, Espeland MA, Lewis CE, LaRose JG, Gorin AA, Bahnson J, Perdue LH, Hatley KE, Ferguson E, Garcia KR, Lang W. Innovative Self-Regulation Strategies to Reduce Weight Gain in Young Adults: The Study of Novel Approaches to Weight Gain Prevention (SNAP) Randomized Clinical Trial. JAMA Intern Med 2016; 176:755-62. [PMID: 27136493 PMCID: PMC5461816 DOI: 10.1001/jamainternmed.2016.1236] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Weight gain occurs commonly in young adults and has adverse effects on health. OBJECTIVE To compare 2 self-regulation interventions vs control in reducing weight gain in young adults over a mean follow-up of 3 years. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial in 2 academic settings of 599 participants aged 18 to 35 years with body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 21.0 to 30.0, recruited via mailings and emails from August 2010 to February 2012. Data were analyzed from January 2015 to January 2016. INTERVENTIONS Participants were randomized to control, self-regulation plus small changes, or self-regulation plus large changes. Both interventions focused on frequent self-weighing to cue behavior changes. "Small changes" taught participants to reduce intake and increase activity, both by approximately 100 calories per day. "Large changes" focused on losing 2.3 to 4.5 kg initially to buffer against expected weight gain. MAIN OUTCOMES AND MEASURES Changes in weight from baseline over mean follow-up of 3 years. Secondary outcomes included proportion gaining at least 0.45 kg from baseline, proportion developing obesity (BMI, ≥30.0), and weight change baseline to 2 years. RESULTS Among the 599 participants (22% men; 27% minority; mean [SD] age, 27.7 [4.4] years; mean [SD] BMI, 25.4 [2.6]), mean (SE) weight changes over a mean follow-up of 3 years were 0.26 (0.22), -0.56 (0.22), and -2.37 (0.22) kg in the control, small-changes, and large-changes groups, respectively (P < .001). Differences among all 3 groups were significant (large changes vs control, P < .001; small changes vs control, P = .02; large changes vs small changes, P < .001). On secondary outcomes, both interventions significantly reduced incidence of obesity relative to control (mean [SE], 8.6% [2.0%], 7.9% [2.0%], and 16.9% [2.7%] in the large-changes, small-changes, and control groups, respectively; P = .02 for large changes vs control and P = .002 for small changes vs control); a smaller percentage of participants in the large-changes group gained 0.45 kg or more (mean [SE], 23.6% [2.8%], 32.5% [3.8%], and 40.8% [4.4%], respectively; P < .001 vs control and P = .02 vs small changes) and weight change from baseline to 2 years was greater in control than in small or large changes (mean [SE], 0.54 [0.33], -0.77 [0.33], and -1.50 [0.34] kg, respectively; P = .02 vs small changes and P < .001 vs large changes). CONCLUSIONS AND RELEVANCE Self-regulation with large or small changes both reduced weight gain in young adults over 3 years relative to control, but the large-changes intervention was more effective. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01183689.
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Affiliation(s)
- Rena R. Wing
- Alpert Medical School of Brown University, the Miriam Hospital
| | | | | | | | | | | | | | | | | | - Erica Ferguson
- Alpert Medical School of Brown University, the Miriam Hospital
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Aschbrenner KA, Mueser KT, Naslund JA, Gorin AA, Kinney A, Daniels L, Bartels SJ. Feasibility Study of Increasing Social Support to Enhance a Healthy Lifestyle Intervention for Individuals with Serious Mental Illness. J Soc Social Work Res 2016; 7:289-313. [PMID: 28168015 PMCID: PMC5291178 DOI: 10.1086/686486] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Healthy lifestyle interventions addressing obesity in people with serious mental illness (SMI) lead to modest weight losses that tend not to be sustained over time. By augmenting lifestyle interventions with family and peer support targeting health behavior change, greater weight loss might be obtained and sustained in this population. The purpose of this study was to assess the feasibility of increasing support from family and friends to enhance a healthy lifestyle intervention (In SHAPE) adapted for individuals with SMI. METHOD A sample of 7 dyads (14 total participants) participated in this small-scale open-feasibility trial of social support strategies to enhance health promotion. Weekly 1-hour health coaching sessions were augmented by sessions designed to increase support for healthy eating and exercise through active learning and didactic instruction. Feasibility was assessed by program participation and by examining participants' satisfaction and exploring suggestions for improving the model post-intervention. RESULTS The majority of participants (57%) nominated a friend, followed by adult child-parent pairs (28%) and sibling pairs (14%) to participate as support partners in the study. All participant-partner dyads (100%) completed 12 sessions within 16 weeks. Participants reported high satisfaction and perceived benefits from the program. Recommend modifications by the dyads included more interactive sessions, a combination of group and dyadic sessions, and hands-on cooking classes. CONCLUSIONS This formative research showed that the study design is feasible and that the intervention can facilitate social support for health behavior change in people with SMI. Further research is needed to evaluate the effectiveness of this intervention.
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Affiliation(s)
| | - Kim T Mueser
- Boston University Center for Psychiatric Rehabilitation
| | - John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice
| | | | - Allison Kinney
- The Dartmouth Institute for Health Policy and Clinical Practice
| | - Lucas Daniels
- The Dartmouth Institute for Health Policy and Clinical Practice
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Abstract
Young adults are underrepresented in standard behavioral weight loss trials, and evidence suggests that they differ from older adults on many weight-related constructs. The aim of this review is to explore young adults' attitudes toward obesity and weight management, with particular attention to those factors that may play a role in the development of future treatment efforts. Both intrapersonal and interpersonal considerations unique to young adulthood are assessed; in addition, we examine young adults' perceptions of specific weight-related behaviors such as dieting, physical activity, and self-weighing. Conclusions are consistent with other findings suggesting that weight management interventions should be adapted and designed specifically for this age group.
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Affiliation(s)
- Autumn Lanoye
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, PO Box 842018, Richmond, VA, 23284, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 4th Floor, Richmond, VA, 23219, USA
| | - Amy A Gorin
- Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 4th Floor, Richmond, VA, 23219, USA.
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Braun TD, Park CL, Gorin AA, Garivaltis H, Noggle JJ, Conboy LA. Group-Based Yogic Weight Loss with Ayurveda-Inspired Components: A Pilot Investigation of Female Yoga Practitioners and Novices. Int J Yoga Therap 2016; 26:55-72. [PMID: 27797660 DOI: 10.17761/1531-2054-26.1.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Overweight/obesity is a pressing international health concern and conventional treatments demonstrate poor long-term efficacy. Preliminary evidence suggests yoga and Ayurveda may be promising approaches, although recent NHIS estimates indicate rare utilization of Ayurveda in the US. Group-based curricula that integrate yoga and Ayurveda-inspired principles to attenuate overweight and obesity across individuals may prove a feasible, disseminable clinical adjunct to facilitate psychosocial health and weight loss and/or maintenance. AIMS Determine feasibility and preliminary effectiveness of a ten-week yoga - based, Ayurveda-inspired weight management curriculum (YWL) piloted in female yoga practitioners (Study 1) then refined and tailored for yoga naïves (Study 2), on self-reported psychosocial process variables and % of self-reported total body weight loss (%TBWL). METHODOLOGY Study 1 enrolled 22 yoga-experienced women (48.2 ± 14.3 years, BMI 30.8 ± 4.2 kg/m2) in a 10-week yoga-based program (YWL-YE). Study 2 enrolled 21 yoga- naïve women (49.4 ± 10.7 years, BMI 35.5 ± 6.8 kg/m2) in a revised 10-week program (YWL-YN). Self-reported weight and self-ratings of mindful eating behavior, body image disturbance, weight loss self-efficacy, body awareness, and self-compassion were collected at baseline, post-treatment (T2), and 3-month follow- up (T3). RESULTS YWL curricula was feasible in both studies. While attrition rates for both studies favorably compared to other weight management studies, attrition was higher for YWL-YN (28.6%) than YWL-YE (18.2%). In both studies, self-reported process variables and self-reported % TBWL changed in hypothesized directions at T2 and evidenced greater improvement at T3; effect sizes across all process variables were medium (-0.4) to large (-1.8). % TBWL reached clinical significance (>5%) only at T3 for the YWL-YE group. CONCLUSIONS The YWL curricula employed here appear to improve psychosocial health among both overweight/obese yoga-experienced and yoga- naïve women. Results must be interpreted with caution due to study design, self-report assessments, and other limitations. Nonetheless, hypotheses are generated for future investigation.
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Affiliation(s)
- Tosca D Braun
- 1. University of Connecticut, Department of Psychology, Storrs, CT
| | - Crystal L Park
- 1. University of Connecticut, Department of Psychology, Storrs, CT
| | - Amy A Gorin
- 1. University of Connecticut, Department of Psychology, Storrs, CT
| | | | - Jessica J Noggle
- 2. Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Lisa A Conboy
- 3. Harvard Medical School, Osher Research Center, Department of Biomedicine, Boston, MA
- 4. New England School of Acupuncture, Newton, MA
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50
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Hagobian TA, Phelan S, Gorin AA, Phipps MG, Abrams B, Wing RR. Effects of maternal lifestyle intervention during pregnancy on untreated partner weight: Results from fit for delivery study. Obesity (Silver Spring) 2016; 24:23-5. [PMID: 26637985 PMCID: PMC4688135 DOI: 10.1002/oby.21368] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/19/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To test the hypothesis that untreated partners of pregnant women receiving a prenatal lifestyle intervention (vs. standard care) would lose more weight during pregnancy and postpartum. METHODS Fit for Delivery was a study of 401 pregnant women with overweight/obesity (OW/OB) and normal weight (NW) randomized to prenatal lifestyle intervention or standard care. Mother's self-report of partners' weight was obtained at study entry (<16 weeks gestation), 30 weeks gestation, and 6 and 12 months postpartum. RESULTS At study entry, 157 of 200 (78%) of intervention mothers and 144 of 201 (72%) of standard care mothers reported having a partner. In intent-to-treat analyses, there was no significant treatment × time effects on partner weight (P = 0.67). In secondary analyses, partners of OW/OB intervention women lost weight from study entry to 6 and 12 months postpartum (-0.5 ± 9.5 kg, -1.0 ± 9.3 kg; P < 0.05), while partners of standard care women gained weight during the same time frame (+2.5 ± 6.7 kg, +2.9 ± 7.4 kg; P < 0.05); adjusting for partner study entry BMI removed these effects. CONCLUSIONS Lifestyle intervention delivered to pregnant women did not significantly reduce weight of untreated partners. Future research is needed to test prenatal interventions that engage partners and use objective measures of weight.
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Affiliation(s)
- Todd A Hagobian
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California, USA
| | - Suzanne Phelan
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California, USA
- Miriam Hospital, Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
| | - Amy A Gorin
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Maureen G Phipps
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University Women & Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Barbara Abrams
- School of Public Health, University of California, Berkeley, California, USA
| | - Rena R Wing
- Miriam Hospital, Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
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