Interventions to prevent weight gain: A systematic review of psychological models and behavior change methods

General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
International Journal of Obesity (Impact Factor: 5). 03/2000; 24(2):131-43. DOI: 10.1038/sj.ijo.0801100
Source: PubMed

ABSTRACT To identify and review published interventions aimed at the prevention of weight gain.
A systematic review of published interventions aimed at the prevention of weight gain.
Search strategies-we searched eight databases, manually checked reference lists and contacted authors. Inclusion and exclusion criteria-studies of any design, in which participants were selected regardless of weight or age, were included. Interventions targeting a specific subgroup, multifactorial interventions, interventions aimed at weight loss, and those with an ambiguous aim were excluded. Data extraction-data were extracted on behaviours targeted for change, psychological model, behaviour change methods and modes of delivery, methodological quality, characteristics of participants, and outcomes related to body weight and self-reported diet and physical activity. Classification and validation-a taxonomy of behaviour change programmes was developed and used for classification of underlying model, behaviour change methods, and modes of delivery. The data extraction and subsequent classification were independently validated.
Eleven publications were included, describing five distinct interventions in schools and four in the wider community. Where diet and physical activity were described, positive effects were usually obtained, but all were measured by self-report. Effects on weight were mixed but follow-up was generally short. Smaller effects on weight gain were found among low-income participants, students and smokers. Many participants in the community-based studies were overweight or obese. Study dropout was higher among thinner and lower-income subjects.
Interventions to prevent weight gain exhibited various degrees of effectiveness. Definite statements about the elements of the interventions that were associated with increased effect size cannot be made as only one of the five studies that involved an RCT design reported a significant effect on weight. This intervention involved a correspondence programme and a mix of behaviour change methods including goal setting, self-monitoring and contingencies. Future interventions might be more effective if they were explicitly based on methods of behaviour change that have been shown to work in other contexts. Effective interventions would be more easily replicated if they were explicitly described. Effectiveness might be more precisely demonstrated if more objective measures of physical activity and diet were used, and if the follow-up was over a longer period. International Journal of Obesity (2000) 24, 131-143

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Available from: Ann Louise Kinmonth, Jun 16, 2014
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    • "Management of obesity usually necessitates a combination of lifestyle modification and pharmacological therapy. Surgical interventions, although effective in some circumstances, are not always appropriate [25] [26]. An alternative strategy to surgery is to develop therapeutic agents that can reduce body weight by decreasing the consumption or absorption of food, and/or by increasing energy expenditure [27] [28]. "
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    ABSTRACT: Obesity is a global epidemic and one of the major health burdens of modern times. The prevalence of obesity is increasing worldwide; it constitutes a serious problem in developed as well as developing countries. Beside adults, the number of obese teenagers and children in particular has dramatically increased. Obesity is characterized by accumulation of excess fat in adipose tissues in an extent to produce adverse effects on health, leading to a reduction in life expectancy and/or a raise in health hazards. People are classified as overweight (pre-obese) and obese on the basis of the Body Mass Index (BMI), crude measure which compares weight to height. Obesity is usually associated with and can lead to many disease conditions, mainly type-2 diabetes, cardiac diseases, hypertension, sleep apnea, cerebrovascular incidents, osteoarthritis and certain types of cancers. The tremendously increasing number of reviews on the subject of obesity obviously reflects the amount of investigations currently dedicated to this field. The core of obesity treatment is dieting and physical exercise. The consumption of energy-dense food is reduced versus an increase in that of dietary fibers. Conventional medication relies mainly on drugs which either reduce appetite or inhibit fat absorption. However, drug treatment of obesity despite short-term benefits, is often associated with undesirable harmful side effects, rebound weight gain after discontinuation of drug intake, and the incidence of drug abuse. If diet, exercise and pharmacological therapy are ineffective; surgical intervention may be useful. The anti-obesity potential of natural products if accurately explored might provide an excellent alternative strategy for the scientifically-based development of safe and effective drugs. Especially that, they are actually widespread for this purpose as nutritional supplements. OTC anti-obesity natural products are mostly complex in terms of chemical composition and may exert a variety of pharmacological actions leading to weight loss. These include: inhibition of lipases activity, suppression of appetite, stimulation of energy expenditure, inhibition of adipocyte differentiation and regulation of lipid metabolism. A variety of natural products, including crude extracts and isolated compounds induce body weight reduction and prevent diet-induced obesity. Examples of these constituents are polyphenols, triterpenoidal and steroidal saponins, pregnane glycosides, alkaloids, abietane diterpenes and carotenoids amongst others. In addition, a number of lipase inhibitors are obtained from microbial sources.
    09/2014: pages 130-210;
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    • "Michie et al. [37] developed a framework consisting of 11 theoretical domains (plus nature of the behaviours) said to encompass the determinants of behaviour change: (1) knowledge, (2) environmental context and resources, (3) motivation and goals (intention), (4) beliefs about capabilities (self-efficacy), (5) emotion, (6) social influences (norms), (7) skills, (8) beliefs about consequences (anticipated outcomes), (9) action planning, 10) memory, attention and decision processes, and 11) social and professional role and identity. It was intended that the use of this explanatory determinant list would allow for the selection and combination of effective behaviour change techniques (BCTs) and methods, based on over a century of research, to achieve desired behaviour change [79,80]. Since then, BCTs based on empirically supported theory have been mapped on to each of the 11 behavioural determinants [38]. "
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    ABSTRACT: Interventions that make extensive use of theory tend to have larger effects on behaviour. The Intervention Mapping (IM) framework incorporates theory into intervention design, implementation and evaluation, and was applied to the development of a community-based childhood obesity prevention intervention for a multi-ethnic population. IM was applied as follows: 1) Needs assessment of the community and culture; consideration of evidence-base, policy and practice; 2) Identification of desired outcomes and change objectives following identification of barriers to behaviour change mapped alongside psychological determinants (e.g. knowledge, self-efficacy, intention); 3) Selection of theory-based methods and practical applications to address barriers to behaviour change (e.g., strategies for responsive feeding); 4) Design of the intervention by developing evidence-based interactive activities and resources (e.g., visual aids to show babies stomach size). The activities were integrated into an existing parenting programme 5) Adoption and implementation: parenting practitioners were trained by healthcare professionals to deliver the programme within Children Centres. HAPPY (Healthy and Active Parenting Programme for Early Years) is aimed at overweight and obese pregnant women (BMI > 25); consists of 12 x 2.5 hr. sessions (6 ante-natal from 24 weeks; 6 postnatal up to 9 months); it addresses mother's diet and physical activity, breast or bottle feeding, infant diet and parental feeding practices, and infant physical activity. We have demonstrated that IM is a feasible and helpful method for providing an evidence based and theoretical structure to a complex health behaviour change intervention. The next stage will be to assess the impact of the intervention on behaviour change and clinical factors associated with childhood obesity. The HAPPY programme is currently being tested as part of a randomised controlled feasibility trial.
    International Journal of Behavioral Nutrition and Physical Activity 12/2013; 10(1):142. DOI:10.1186/1479-5868-10-142 · 4.11 Impact Factor
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    • "Previous studies have also found that goal setting, action plans and structured programmes of care are effective in promoting lifestyle change [27-30] but goal setting itself is not sufficient to effect change [31]. However, behaviour change interventions which are based on psychological theory have more positive results than those delivered by teaching and merely giving information [32]. A collaborative approach involving both professional and patient is necessary, with recognition of the patient’s social networks, responsibilities and culture to help them overcome hindrances to lifestyle change. "
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    ABSTRACT: Healthy lifestyles help to prevent coronary heart disease (CHD) but outcomes from secondary prevention interventions which support lifestyle change have been disappointing. This study is a novel, in-depth exploration of patient factors affecting lifestyle behaviour change within an intervention designed to improve secondary prevention for patients with CHD in primary care using personalised tailored support. We aimed to explore patients' perceptions of factors affecting lifestyle change within a trial of this intervention (the SPHERE Study), using semi-structured, one-to-one interviews, with patients in general practice. Interviews (45) were conducted in purposively selected general practices (15) which had participated in the SPHERE Study. Individuals, with CHD, were selected to include those who succeeded in improving physical activity levels and dietary fibre intake and those who did not. We explored motivations, barriers to lifestyle change and information utilised by patients. Data collection and analysis, using a thematic framework and the constant comparative method, were iterative, continuing until data saturation was achieved. We identified novel barriers to lifestyle change: such disincentives included strong negative influences of social networks, linked to cultural norms which encouraged consumption of 'delicious' but unhealthy food and discouraged engagement in physical activity. Findings illustrated how personalised support within an ongoing trusted patient-professional relationship was valued. Previously known barriers and facilitators relating to support, beliefs and information were confirmed. Intervention development in supporting lifestyle change in secondary prevention needs to more effectively address patients' difficulties in overcoming negative social influences and maintaining interest in living healthily.
    BMC Family Practice 08/2013; 14(1):126. DOI:10.1186/1471-2296-14-126 · 1.67 Impact Factor
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