-
[show abstract]
[hide abstract]
ABSTRACT: Background. Rates of body mass index (BMI) calculation and plotting remain low. We examined whether providing a BMI wheel and brief education to pediatric residents and attendings would increase rates of "BMI recognition" and obesity-related counseling. Methods. A delayed-control design was used to evaluate a 20-minute intervention. A total of 1640 records of well-child visits were reviewed to determine the proportion of records in which BMI was calculated and plotted and counseling provided. Results. In clinic A, there was a significant increase in the proportion of records in which BMI was recognized from pre- to postintervention (P < .01). No changes in clinic B occurred until after the delayed intervention. Obesity-related counseling was more likely to occur if BMI was recognized. Conclusion. Brief education and BMI wheel increased rates of BMI recognition. BMI recognition was associated with increased obesity management. Additional efforts should be incorporated to further increase BMI recognition and assist providers in treating these children.
Clinical Pediatrics 06/2013; · 1.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Objective: Social support is believed to contribute to weight loss success, yet the type of support received is rarely assessed. To develop more effective weight loss interventions, examinations of the types of support that are associated with positive outcomes are needed. Self-Determination Theory suggests that support for an individual's autonomy is beneficial and facilitates internalization of autonomous self-regulation. We examined whether autonomy support and directive forms of support were associated with weight loss outcomes in a larger randomized controlled trial. Method: Adults (N = 201; 48.9 ± 10.5 years; 78.1% women) participating in a weight loss trial were assessed at 0, 6, and 18 months. Autonomy support (AS), directive support, and autonomous self-regulation (ASR) were measured at 0 and 6 months and examined in relation to 18-month weight loss outcomes. Results: Baseline AS and ASR did not predict outcomes; however, AS and ASR at 6 months positively predicted 18-month weight losses (ps < .05), encouragement of healthy eating at 6 months was negatively related to 18-month weight losses (p < .01), and other forms of directive support were not associated with outcomes. Conclusions: Autonomy support predicted better weight loss outcomes while some forms of directive support hindered progress. Weight loss trials are needed to determine whether family members and friends can be trained to provide autonomy support and whether this is more effective than programs targeting more general or directive forms of support. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Health Psychology 06/2013; · 3.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Weight gain during young adulthood is common and is associated with increased cardiovascular risk. Preventing this weight gain from occurring may be critical to improving long-term health. Few studies have focused on weight gain prevention, and these studies have had limited success. SNAP (Study of Novel Approaches to Weight Gain Prevention) is an NIH-funded randomized clinical trial examining the efficacy of two novel self-regulation approaches to weight gain prevention in young adults compared to a minimal treatment control. The interventions focus on either small, consistent changes in eating and exercise behaviors, or larger, periodic changes to buffer against expected weight gains. METHODS: SNAP targets recruitment of six hundred young adults (18--35 years) with a body mass index between 23.0-30.0 kg/m2, who will be randomly assigned with equal probability to: (1) minimal intervention control; (2) self-regulation with Small Changes; or (3) self-regulation with Large Changes. Both interventions receive 8 weekly face-to-face group sessions, followed by 2 monthly sessions, with two 4-week refresher courses in subsequent years. Participants are instructed to report weight via web at least monthly thereafter, and receive monthly e-mail feedback. Participants in Small Changes are taught to make small daily changes (~100 calorie changes) in how much or what they eat and to accumulate 2000 additional steps per day. Participants in Large Changes are taught to create a weight loss buffer of 5--10 pounds once per year to protect against anticipated weight gains. Both groups are encouraged to self-weigh daily and taught a self-regulation color zone system that specifies action depending on weight gain prevention success. Individualized treatment contact is offered to participants who report weight gains. Participants are assessed at baseline, 4 months, and then annually. The primary outcome is weight gain over an average of 3 years of follow-up; secondary outcomes include diet and physical activity behaviors, psychosocial measures, and cardiovascular disease risk factors. DISCUSSION: SNAP is unique in its focus on weight gain prevention in young adulthood. The trial will provide important information about whether either or both of these novel interventions are effective in preventing weight gain. (ClinicalTrials.gov NCT 01183689)Trial registration: NCT 01183689. http://clinicaltrials.gov/ct2/show/NCT01183689?term=NCT+01183689&rank=1.
BMC Public Health 04/2013; 13(1):300. · 2.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Research demonstrates a link between migraine and obesity. Obesity increases the risk of frequent migraines and is associated with migraine prevalence among reproductive-aged women. These findings are substantiated by several plausible mechanisms and emerging evidence of migraine improvements after surgical and non-surgical weight loss. However, no previous study has examined the effect of weight loss on migraine within a treatment-controlled framework. The WHAM trial is a RCT to test the efficacy of behavioral weight loss as a treatment for migraine. STUDY DESIGN: Overweight/obese women (n=140; BMI=25.0-49.9 kg/m(2)) who meet international diagnostic criteria for migraine and record ≥3 migraines and 4-20 migraine days using a smartphone-based headache diary during a 4-week baseline period, will be randomly assigned to 4 months of either group-based behavioral weight loss (intervention) or migraine education (control). Intervention participants will be taught strategies to increase physical activity and consume fewer calories in order to lose weight. Control participants will receive general education on migraine symptoms/triggers and various treatment approaches. Both groups will use smartphones to record their headaches for 4 weeks at baseline, after the 16-week treatment period, and at the end of a 16-week follow-up period. Changes in weight and other potential physiological (inflammation), psychological (depression), and behavioral (diet and physical activity) mediators of the intervention effect will also be assessed. CONCLUSION: The WHAM trial will evaluate the efficacy of a standardized behavioral weight loss intervention for reducing migraine frequency, and the extent to which weight loss and other potential mediators account for intervention effects.
Contemporary clinical trials 03/2013; · 1.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Objective: To develop and validate the Weight Control Strategies Scale (WCSS), a self-report instrument to assess use of specific behaviors thought to facilitate weight loss. Design and Methods: Factor analysis was conducted on 323 overweight and obese adults (mean age=48.7±10.9 years, mean BMI=35.4±4.9 kg/m(2) , 74% female) enrolled in three different behavioral weight loss trials who completed the WCSS prior to starting treatment. To evaluate construct validity, additional data on dietary intake, physical activity, treatment session attendance, and weight change were obtained from a subsample of participants before and after participation in a 48-week weight loss program. Results: Principal components analysis with varimax rotation revealed a four component solution for the WCSS, representing the following subscales: Dietary Choices, Self-monitoring Strategies, Physical Activity, and Psychological Coping (α's from 0.79-0.89). Longitudinal analyses showed that WCSS subscale scores increased during treatment (p's <0.01). In adjusted models, changes in WCSS total and subscale scores were associated with posttreatment weight loss (p's <0.01). Additionally, changes in WCSS Dietary Choices and Physical Activity subscales were related to posttreatment changes in total daily kilocalorie consumption (p=0.019) and weekly kilocalorie expenditure through physical activity (p<0.001), respectively. Conclusions: Findings support the validity and reliability of the WCSS in a weight loss treatment seeking sample.
Obesity 03/2013; · 4.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Shaping network members into sources of support for healthy eating and exercise behaviors may be an effective strategy to enhance obesity treatment outcomes. This pilot study examined the feasibility and preliminary efficacy of a behavioral weight loss intervention adapted for Latinas with a social network component. Twenty-seven Latinas (43.0±10.2 years and body mass index 36.9±5.7) participated in a 24-week randomized controlled intervention study. Participants attended group-based treatment either individually (Individual Lifestyle Group [ILG]) or with a weight loss partner selected from their existing network (Partner Lifestyle Group [PLG]). Repeated measures analysis of variance was conducted to compare ILG and PLG participants on changes in weight or psychosocial variables. Participants in both intervention groups attended 70% of treatment sessions; 96% and 100% completed assessment at post-treatment (12 weeks) and follow-up (24 weeks), respectively. Significant weight loss (P<0.01) was achieved at post-treatment (ILG -4.7±4.2 kg and PLG -4.3±4.4 kg) and follow-up (ILG -5.0±6.4 kg and PLG -4.7±5.0 kg), with nearly 50% of participants losing at least 5% of initial body weight. Both groups also experienced increased self-efficacy for weight loss (P<0.01), self-efficacy for exercise (P=0.02), and family social support for exercise habits (P=0.01). There were no significant differences between groups. Results from this study suggest a behavioral weight loss intervention for Latinas is feasible, but there is less support for the efficacy of weight loss partners.
Journal of the Academy of Nutrition and Dietetics. 03/2013;
-
[show abstract]
[hide abstract]
ABSTRACT: Severe obesity (body mass index [BMI] ≥40 kg/m(2)) is a serious public health concern. Although bariatric surgery is an efficacious treatment approach, it is limited in reach; thus, nonsurgical treatment alternatives are needed. We examined the 4-year effects of an intensive lifestyle intervention on body weight and cardiovascular disease risk factors among severely obese, compared with overweight (25 ≤BMI <30), class I (30 ≤BMI <35), and class II obese (35 ≤BMI <40) participants.
There were 5145 individuals with type 2 diabetes (45-76 years, BMI ≥25 kg/m(2)) randomized to an intensive lifestyle intervention or diabetes support and education. The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings, a ≥10% weight loss goal, calorie restriction, and increased physical activity. Diabetes support and education received a less intense educational intervention. Four-year changes in body weight and cardiovascular disease risk factors were assessed.
Across BMI categories, 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education (Ps <.05). At year 4, severely obese lifestyle participants lost 4.9%±8.5%, which was similar to class I (4.8%±7.2%) and class II obese participants (4.4%±7.6%), and significantly greater than overweight participants (3.4%±7.0%; P <.05). Four-year changes in low-density-lipoprotein cholesterol, triglycerides, diastolic blood pressure, HbA(1c), and blood glucose were similar across BMI categories in lifestyle participants; however, the severely obese had less favorable improvements in high-density-lipoprotein cholesterol (3.1±0.4 mg/dL) and systolic blood pressure (-1.4±0.7 mm Hg) compared with the less obese (Ps <.05).
Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals.
The American journal of medicine 03/2013; 126(3):236-242.e2. · 4.47 Impact Factor
-
Richard R Rubin,
Mark Peyrot,
Sarah A Gaussoin,
Mark A Espeland,
Don Williamson,
Lucy F Faulconbridge,
Thomas A Wadden,
Linda Ewing,
Monika Safford,
Gina Evans-Hudnall, Rena R Wing,
William C Knowler
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE
To study the association of depressive symptoms or antidepressant medicine (ADM) use with subsequent cardiovascular disease (CVD) risk factor status in the Look AHEAD (Action for Health in Diabetes) trial of weight loss in type 2 diabetes.RESEARCH DESIGN AND METHODS
Participants (n = 5,145; age [mean ± SD] 58.7 ± 6.8 years; BMI 35.8 ± 5.8 kg/m(2)) in two study arms (intensive lifestyle [ILI], diabetes support and education [DSE]) completed the Beck Depression Inventory (BDI), reported ADM use, and were assessed for CVD risk factors at baseline and annually for 4 years. Risk factor-positive status was defined as current smoking, obesity, HbA(1c) >7.0% or insulin use, and blood pressure or cholesterol not at levels recommended by expert consensus panel or medicine to achieve recommended levels. Generalized estimating equations assessed within-study arm relationships of elevated BDI score (≥11) or ADM use with subsequent year CVD risk status, controlled for demographic variables, CVD history, diabetes duration, and prior CVD risk status.RESULTSPrior year elevated BDI was associated (odds ratio [95% CI]) with subsequent CVD risk factor-positive status for the DSE arm (A1C [1.30 (1.09-1.56)]; total cholesterol [0.80 (0.65-1.00)]; i.e., protective from high total cholesterol) and the ILI arm (HDL [1.40 (1.12-1.75)], triglyceride [1.28 (1.00-1.64)]). Prior year ADM use predicted subsequent elevated CVD risk status for the DSE arm (HDL [1.24 (1.03-1.50)], total cholesterol [1.28 (1.05-1.57)], current smoking [1.73 (1.04-2.88)]) and for the ILI arm (A1C [1.25 (1.08-1.46)], HDL [1.32 (1.11-1.58)], triglycerides [1.75 (1.43-2.14)], systolic blood pressure [1.39 (1.11-1.74)]), obesity [1.46 (1.22-2.18)]).CONCLUSIONS
Aggressive monitoring of CVD risk in diabetic patients with depressive symptoms or who are treated with ADM may be warranted.
Diabetes care 01/2013; · 8.09 Impact Factor
-
Edward W Gregg,
Haiying Chen,
Lynne E Wagenknecht,
Jeanne M Clark,
Linda M Delahanty,
John Bantle,
Henry J Pownall,
Karen C Johnson,
Monika M Safford,
Abbas E Kitabchi,
F Xavier Pi-Sunyer, Rena R Wing,
Alain G Bertoni
[show abstract]
[hide abstract]
ABSTRACT: CONTEXT The frequency of remission of type 2 diabetes achievable with lifestyle intervention is unclear. OBJECTIVE To examine the association of a long-term intensive weight-loss intervention with the frequency of remission from type 2 diabetes to prediabetes or normoglycemia. DESIGN, SETTING, AND PARTICIPANTS Ancillary observational analysis of a 4-year randomized controlled trial (baseline visit, August 2001-April 2004; last follow-up, April 2008) comparing an intensive lifestyle intervention (ILI) with a diabetes support and education control condition (DSE) among 4503 US adults with body mass index of 25 or higher and type 2 diabetes. INTERVENTIONS Participants were randomly assigned to receive the ILI, which included weekly group and individual counseling in the first 6 months followed by 3 sessions per month for the second 6 months and twice-monthly contact and regular refresher group series and campaigns in years 2 to 4 (n=2241) or the DSE, which was an offer of 3 group sessions per year on diet, physical activity, and social support (n=2262). MAIN OUTCOME MEASURES Partial or complete remission of diabetes, defined as transition from meeting diabetes criteria to a prediabetes or nondiabetic level of glycemia (fasting plasma glucose <126 mg/dL and hemoglobin A1c <6.5% with no antihyperglycemic medication). RESULTS Intensive lifestyle intervention participants lost significantly more weight than DSE participants at year 1 (net difference, -7.9%; 95% CI, -8.3% to -7.6%) and at year 4 (-3.9%; 95% CI, -4.4% to -3.5%) and had greater fitness increases at year 1 (net difference, 15.4%; 95% CI, 13.7%-17.0%) and at year 4 (6.4%; 95% CI, 4.7%-8.1%) (P < .001 for each). The ILI group was significantly more likely to experience any remission (partial or complete), with prevalences of 11.5% (95% CI, 10.1%-12.8%) during the first year and 7.3% (95% CI, 6.2%-8.4%) at year 4, compared with 2.0% for the DSE group at both time points (95% CIs, 1.4%-2.6% at year 1 and 1.5%-2.7% at year 4) (P < .001 for each). Among ILI participants, 9.2% (95% CI, 7.9%-10.4%), 6.4% (95% CI, 5.3%-7.4%), and 3.5% (95% CI, 2.7%-4.3%) had continuous, sustained remission for at least 2, at least 3, and 4 years, respectively, compared with less than 2% of DSE participants (1.7% [95% CI, 1.2%-2.3%] for at least 2 years; 1.3% [95% CI, 0.8%-1.7%] for at least 3 years; and 0.5% [95% CI, 0.2%-0.8%] for 4 years). CONCLUSIONS In these exploratory analyses of overweight adults, an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes compared with diabetes support and education. However, the absolute remission rates were modest. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00017953.
JAMA The Journal of the American Medical Association 12/2012; 308(23):2489-2496. · 30.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Commercial weight loss programs such as Weight Watchers (WW) offer widely recognized and accessible treatment, but typically produce weight losses that are modest relative to professionally delivered programs. This study tested the hypothesis that a novel weight loss approach that combined the fundamental components of professionally delivered behavioral weight loss (BWL) treatment with the existing WW program would produce better weight losses than WW alone; no differences were expected between the novel treatment and BWL alone. Participants were 141 overweight and obese adults (90% women, 67% non-White, mean age = 49.7 ± 9.2 years, mean BMI = 36.2 ± 5.5 kg/m(2) ) randomly assigned to 48 weeks of BWL, 48 weeks of WW, or 12 weeks of BWL followed by 36 weeks of WW (Combined Treatment, CT). Assessments were conducted at baseline and weeks 12, 24, and 48, with weight change as the primary outcome. Linear mixed model analysis showed that 24-week weight losses did not differ significantly between treatment groups; however, weight losses at 48 weeks were greater in the WW group (M=6.0 kg, SE=0.8) compared to the CT group (M=3.6 kg, SE=0.8; p=0.032), with BWL not significantly different from either (M=5.4 kg, SE=0.8). Further, a greater proportion of WW participants lost 10% of baseline weight by 48 weeks compared to BWL or CT (36.7%, 10.9%, and 15.2%, respectively, p's<0.01). This study shows that the WW program can produce clinically meaningful weight losses and provides no evidence that adding brief BWL to the WW program improves outcome.
Obesity 10/2012; · 4.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The goal of this study was to compare young adults (YA) and older adults (OA) in the National Weight Control Registry on motivations for weight loss and weight loss behaviors. Participants (N=2,964, 82% female, 94% White, BMI=24.8±4.4) were divided into two age groups (18-35 vs. 36-50) and compared on motivations, strategies for weight loss, diet, physical activity (PA), and the TFEQ. YA were 28.6% of the sample (n=848). YA and OA achieved similar weight losses (p=.38) but duration of maintenance was less in YA (43 vs. 58 months, p<001). YA were more likely to cite appearance and social motivations for weight loss, were less motivated by health, and were less likely to report a medical trigger for weight loss (p's<.001). YA were more likely to use exercise classes and to lose weight on their own, and less likely to use a commercial program (p's<.001). YA reported engaging in more high intensity PA (p=.001). There were no group differences in total calories consumed (p=.47), or percent calories from fat (p=.97), alcohol (p=.52) or sugar sweetened beverages (p=.26). In sum, YA successful weight losers (SWL) are motivated more by appearance and social influences than OA, and physical activity appears to play an important role in their weight loss efforts. The differences reported by YA and OA SWL should be considered when developing weight loss programs for YA.
Obesity 10/2012; · 4.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Sedentary behavior (SB), independent of physical activity, represents a significant health risk. We previously used objective measures to demonstrate that bariatric surgery candidates engage in high levels of SB overall, but supplementing these measures with subjective reports would provide information about time allocated to different forms of SB. The aim of this study was to examine self-reported time spent performing specific types of SB and discrepancy between self-reported and objectively measured estimates of total sedentary time in bariatric surgery candidates. METHODS: A total of 52 bariatric surgery candidates (87% female; age = 46.2±9.1 years; body mass index [BMI] = 45.3±6.7) completed the 9-item Sedentary Behavior Questionnaire (SBQ) as a subjective measure of SB and wore the SenseWear Armband (SWA; SenseWear, Pittsburgh, PA) as an objective measure. Paired samples t tests and the intraclass correlation coefficient (ICC) assessed measurement discrepancy. RESULTS: Television-viewing was the most frequently performed type of SB (2.7±1.6 hours per day), followed by paper/computer work (1.9±1.8 hours per day), driving/riding in automobile (1.2±1.1 hours per day), and sitting/talking on telephone (1.1±1.2 hours per day). On average, the SBQ and SWA produced similar estimates of daily sedentary time (hours per day) at the group level (9.6±4.8 versus 9.3±1.9; mean difference = -.34±4.6; P = .59), although agreement between the measures at the individual level was poor (mean absolute value of difference = 3.8±2.8 hours per day; ICC = .22; P = .06). CONCLUSION: Television-viewing was the single SB in which participants most frequently engaged and thus may be an important modifiable target for reducing total sedentary time in bariatric surgery candidates. The SBQ and SWA can be used similarly to describe SB levels in this patient population at the group level; however, ability of these measures to produce comparable estimates of sedentary time for any individual patient is limited.
Surgery for Obesity and Related Diseases 09/2012; · 3.93 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Severe obesity is characterized by low physical activity (PA) and interventions to enhance PA are needed. Participants (45.0 ± 3.9 kg/m 2) were randomized to a 6-month standard behavioral weight loss program (SBWL; n = 14) or SBWL+technology (SBWL+TECH; n = 15). Both groups received identical SBWL treatment and SBWL+TECH also received a wearable PA monitor, providing "real-time" feedback, and website access to monitor energy balance. 6-month retention was similar between groups (SBWL: 12/13 versus SBWL+TECH: 11/14 completers; P = 0.19) and adherence to wearing the armband was excellent (91.3% of days). Although differences in PA between groups did not meet conventional thresholds of significance, SBWL+TECH increased their moderate-to-vigorous intensity PA by 132.9 ± 216.8 min/week, which was 3 times greater than SBWL (44.8 ± 124.3 min/week; P = 0.27; Cohen's d = 0.50). There was a trend for SBWL+TECH to self-monitor for a greater proportion of days compared to SBWL (86.2 ± 21.4% versus 71.5 ± 19.4%; P = 0.098; Cohen's d = 0.72). The difference in weight loss between groups was modest (SBWL+TECH: −10.0 ± 7.1% versus SBWL: −7.8 ± 6.7%; P = 0.46). These preliminary findings suggest that PA monitors may be one strategy for increasing PA among the severely obese. Larger, long-term trials are needed.
Obesity 09/2012; · 4.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate the effect of a decrease in urinary incontinence (UI) frequency on UI management costs among women enrolled in a clinical trial of a weight loss intervention and to identify factors that predict change in cost.
This is a secondary cohort analysis of 338 obese and overweight women with 10 or more weekly episodes of UI enrolled in an 18-month randomized clinical trial of a weight loss intervention compared with a structured education program to treat UI. Quantities of resources used for incontinence management, including pads, additional laundry, and dry cleaning, were reported by participants. Direct costs for UI management ("cost") were calculated by multiplying resources used by national resource costs (in 2006 U.S. dollars). Randomized groups were combined to examine the effects of change in incontinence frequency on cost. Possible predictors of change in cost were examined using generalized estimating equations controlling for factors associated with change in cost in univariable analyses.
Mean age±standard deviation was 53±10 years and baseline weight was 97±17 kg. Mean weekly UI frequency was 24±18 at baseline and decreased by 37% at 6 months and 60% at 18 months' follow-up (both P<.001). At baseline, adjusted mean cost was $7.76±$14 per week, with costs increasing significantly with greater incontinence frequency. Mean cost decreased by 54% at 6 months and 81% at 18 months (both P<.001). In multivariable analyses, cost independently decreased by 23% for each decrease of seven UI episodes per week and 21% for each 5 kg of weight lost (P<.001 for both).
In obese and overweight women enrolled in a clinical trial of weight loss for UI, incontinence management cost decreased by 81% at 18 months ($327 per woman per year) and was strongly and independently associated with decreasing incontinence frequency.
II.
Obstetrics and Gynecology 08/2012; 120(2 Pt 1):277-83. · 4.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Given that bariatric surgery (BS) and lifestyle intervention (LI) represent two vastly different approaches to treating severe obesity, there is growing interest in whether individuals who seek BS versus LI also differ on weight-related behaviors. In the present study, we compared BS- and LI-seekers on physical activity (PA) and sedentary behaviors (SB), and examined between-group differences in health-related quality of life (HRQoL), while controlling for PA.
A sample of 34 LI-seekers were matched with 34 BS-seekers on gender, age, BMI, and PA monitor-daily wear time (age: 42.1±10.0 years; BMI: 45.6±6.5 kg/m2). PA and SB were assessed over a 7-day period via the SenseWear Armband (SWA). HRQoL was measured using the SF-36, with scores standardized to a population normal distribution (M=50, SD=10). Participants wore the SWA for 13.7±1.6 h/day. BS-seekers did not differ from LI-seekers on average min/d over the wear period spent in SB (641±117.1 vs. 638.4±133.4, p=0.62) or light (136.4±76.1 vs. 145.5±72.5, p=0.59) and moderate-to-vigorous (>1-min bouts=36.4±26.2 vs. 40.2±31.3, p=0.59; ≥10-min bouts=5.7±8.3 vs. 10.2±17.0, p=0.17) PA. BS-seekers reported significantly lower SF-36 physical functioning (42.4±10.9 vs. 49.0±6.8, p=0.004) and physical component summary (43.9±10.1 vs. 48.9±7.0) scores versus LI-seekers. BS-seeker group status was related to lower physical functioning (β=0.30, p=0.009), independent of gender, age, BMI, and daily PA.
Findings suggest that seeking BS versus LI is not related to patterns of PA or SB, and that lower subjective physical functioning is not associated with lower overall PA levels in BS-seekers.
Health and Quality of Life Outcomes 07/2012; 10:86. · 2.11 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Young adults (YA) are at high risk for insufficient sleep and obesity. However, little research has focused on the association between sleep and obesity in this population. The present study examined the association between reported time in bed (TIB) and body mass index (BMI) in YAs. Participants were 250 18-25 year-olds who completed an online survey assessing several factors associated with weight control. After controlling for significant covariates, TIB was significantly associated with BMI. Specifically, "less than 6 hours/night" TIB was associated with increased BMI compared to the referent category (7 to <8 hours/night) (p = .01). Findings demonstrate that young adults who report shorter TIB are more likely to be classified as having higher BMI.
Behavioral Sleep Medicine 07/2012; · 1.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study examined the 24-month outcomes of a randomized controlled trial of a group-based behavioral weight control (BWC) program combined with either activity-based peer intervention or aerobic exercise.
At baseline, 118 obese adolescents (68% female; BMI = 31.41 ± 3.33) ages 13 to 16 years (mean = 14.33; SD = 1.02) were randomized to receive 1 of 2 weight loss interventions. Both interventions received the same 16-week group-based cognitive-behavioral treatment, combined with either aerobic exercise or peer-based adventure therapy. Eighty-nine adolescents (75% of original sample) completed the 24-month follow-up. Anthropometric and psychosocial measures were obtained at baseline, at the end of the 16-week intervention, and at 12 and 24 months following randomization.
An intent-to-treat mixed factor analysis of variance indicated a significant effect for time on both percent over 50th percentile BMI for age and gender and standardized BMI score, with no differences by intervention group. Post hoc comparisons showed a significant decrease in percent overweight at 4 months (end of treatment), which was maintained at both 12- and 24-month follow-up visits. Significant improvements on several dimensions of self-concept were noted, with significant effects on physical appearance self-concept that were maintained through 24 months.
Both BWC conditions were effective at maintaining reductions in adolescent obesity and improvements in physical appearance self-concept through 24-month follow-up. This study is one of the first to document long-term outcomes of BWC intervention among adolescents.
PEDIATRICS 07/2012; 130(2):e281-8. · 4.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Despite their popularity, empirical support for health coaches is limited. This study examined the feasibility and preliminary efficacy of three types of coaching models for obesity treatment. Participants (N = 44) were randomized to 6 months of reduced intensity group behavioral weight loss (rBWL) plus one of three types of health coaches: (i) Professional (rBWL interventionist), (ii) Peer (group members randomly paired and coached one another), or (iii) Mentor (successful weight loser). Groups met weekly for the first 6 weeks, biweekly for the next 6 weeks, and monthly thereafter, for a total of 12 meetings. During weeks that group did not meet, participants emailed their weight loss information to their coach and received feedback. Coaches were trained on appropriate coaching strategies and feedback delivery. Retention was 95%. Participants emailed their progress to their coach 10.8 ± 1.9 of the 12 weeks that there were no group meetings. Coaches responded with feedback 94% of the time. Percent weight losses at 6 months were 9.6 ± 8.1, 9.1 ± 5.0, and 5.7 ± 5.6 for the Professional, Peer, and Mentor conditions, respectively. More participants in the Professional and Peer conditions lost 10% of their initial body weight (Professional: 56% Peer: 50% and Mentor: 17%), with a statistically significant difference between the Professional and Mentor conditions (P = 0.03). These preliminary data suggest that combining a rBWL program with health coaching may hold significant promise as a cost-effective obesity treatment paradigm. Larger trials are needed to conclusively determine whether adding coaches improves weight loss outcomes in reduced intensity treatments and to examine which type of coach is most effective.
Obesity 06/2012; · 4.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: On average, participants in behavioral weight-loss interventions lose 8 kilograms (kg) at 6 months, but there is marked variability in outcomes with some participants losing little or no weight. Individuals with difficulties with internal disinhibition (i.e., eating in response to emotions or thoughts) typically lose less weight in such programs and may require an innovative, specialized approach. This pilot study examined the preliminary acceptability and efficacy of a 24-week acceptance-based behavioral intervention for weight loss among overweight and obese adults reporting difficulty with eating in response to emotions and thoughts. Participants were 21 overweight or obese men and women (mean age=52.2±7.6 years; baseline mean body mass index=32.8±3.4). Eighty-six percent completed the 6-month program and a 3-month follow-up assessment. Ratings of program satisfaction averaged 4.9 on a five-point scale. Multilevel modeling analyses indicated participants lost an average of 12.0 kg (SE=1.4) after 6 months of treatment and 12.1 kg (SE=1.9) at 3-month follow-up, thus exceeding the weight losses typically seen in behavioral treatment programs. Decreases in internal disinhibition and weight-related experiential avoidance were found at 6- and 3-months follow-up. Greater decreases in weight-related experiential avoidance were associated with greater weight loss at the end of the program (r=.64, p=.002), suggesting a potential mechanism of action. Although there have been a few preliminary studies using acceptance-based approaches for obesity, this is the first study to specifically target emotional overeaters, a subgroup that might be particularly responsive to this new approach. Our findings provide initial support for the feasibility, efficacy, and acceptability of this approach for this subgroup of participants. Further study with longer follow-up, a more diverse sample, and comparison to a standard behavioral program is clearly warranted.
Behavior therapy 06/2012; 43(2):427-35. · 2.85 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cortical thickness of the cognitive control network was contrasted between obese (OB), successful weight loss maintainers (SWLM), and lean individuals. OB individuals had significant thinning, most notably in the anterior cingulate and posterior parietal cortices. SWLM individuals exhibited trends towards thicker cortex than OB individuals, which may be important in future studies.
Psychiatry Research 05/2012; 202(1):77-9. · 2.52 Impact Factor
