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ABSTRACT: Dietary goals specific for lowering energy density (ED) may promote a nutrient-dense diet and weight loss. This pilot study examined the effects of ED-based diet prescriptions on diet quality and weight loss during a 3-month behavior-based obesity intervention conducted in a research setting. Forty-four adults with overweight/obesity (age 52.1±7.6 years, body mass index [BMI; calculated as kg/m(2)] 34.8±4.8, 81.8% women, and 93.2% white) were recruited between December 2009 and March 2010 and randomly assigned to: Low ED (consume ≥10 foods ≤1.0 kcal/g dietary ED and ≤2 foods ≥3.0 kcal/g dietary ED per day (n=15); Low-Energy, Low-Fat (1,200 to 1,500 kcal/day, ≤30% energy from fat (n=15); or Low-ED, Low-Energy, Low-Fat (n=14). Participants received 12 weekly group sessions led by a research interventionist. Dietary intake (measured by 3-day food records), self-reported physical activity, and weight were measured at baseline and 3 months. Intent-to-treat analyses showed all conditions reduced dietary ED and energy intake (P<0.001). Low-ED and Low-ED, Low-Energy, Low-Fat interventions increased fruit consumption (P<0.05). All conditions increased self-reported physical activity (P<0.001), with no difference between conditions. Although participants in all conditions lost weight (P<0.001), those in the Low-ED condition lost more (P<0.05) than those in the Low-ED, Low-Energy, Low-Fat condition (Low-ED -20.5±7.0 lb, Low-Energy, Low-Fat -16.9±10.1 lb, and Low-ED, Low-Energy, Low-Fat -12.5± 6.5 lb). A diet prescription that lowered ED increased fruit intake and enhanced weight loss compared with other weight loss prescriptions.
Journal of the Academy of Nutrition and Dietetics. 05/2012; 112(9):1397-402.
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Suzanne Phelan,
Alka M Kanaya,
Leslee L Subak,
Patricia E Hogan,
Mark A Espeland,
Rena R Wing, Kathryn L Burgio,
Vicki DiLillo, Amy A Gorin,
Delia S West,
Jeanette S Brown
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ABSTRACT: We determined the effect of weight loss on the prevalence, incidence and resolution of weekly or more frequent urinary incontinence in overweight/obese women with type 2 diabetes after 1 year of intervention in the Look AHEAD (Action for Health in Diabetes) trial.
Women in this substudy (2,739, mean ± SD age 57.9 ± 6.8 years, body mass index 36.5 ± 6.1 kg/m(2)) were randomized into an intensive lifestyle weight loss intervention or a diabetes support and education control condition.
At baseline 27% of participants reported urinary incontinence on a validated questionnaire (no significant difference by intensive lifestyle intervention vs diabetes support and education). After 1 year of intervention the intensive lifestyle intervention group in this substudy lost 7.7 ± 7.0 vs 0.7 ± 5.0 kg in the diabetes support and education group. At 1 year fewer women in the intensive lifestyle intervention group reported urinary incontinence (25.3% vs 28.6% in the diabetes support and education group, p = 0.05). Among participants without urinary incontinence at baseline 10.5% of intensive lifestyle intervention and 14.0% of diabetes support and education participants experienced urinary incontinence after 1 year (p = 0.02). There were no significant group differences in the resolution of urinary incontinence (p >0.17). Each kg of weight lost was associated with a 3% reduction in the odds of urinary incontinence developing (p = 0.01), and weight losses of 5% to 10% reduced these odds by 47% (p = 0.002).
Moderate weight loss reduced the incidence but did not improve the resolution rates of urinary incontinence at 1 year among overweight/obese women with type 2 diabetes. Weight loss interventions should be considered for the prevention of urinary incontinence in overweight/obese women with diabetes.
The Journal of urology 03/2012; 187(3):939-44. · 4.02 Impact Factor
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ABSTRACT: Objective: Behavioral weight-loss programs (BWL) provide limited instruction on how to change the environmental context of weight-regulating behaviors, perhaps contributing to regain. Drawing on social ecological models, this trial evaluated a comprehensive weight-loss program that targeted both an individual's behavior and his or her physical and social home environment. Method: Overweight and obese adults (N = 201; 48.9 ± 10.5 years; 78.1% women) were randomized to BWL or to BWL plus home-environment changes (BWL + H). Groups met weekly for 6 months and bimonthly for 12 months. BWL + H participants were given items to facilitate healthy choices in their homes (e.g., exercise equipment, portion plates) and attended treatment with a household partner. Weight loss at 6 and 18 months was the primary outcome. Results: BWL + H changed many aspects of the home environment and produced better 6-month weight losses than BWL (p = .017). At 18 months, no weight-loss differences were observed (p = .19) and rates of regain were equivalent (p = .30). Treatment response was moderated by gender (6 months, p = .011; 18 months, p = .006). Women lost more weight in BWL + H than BWL at 6 and 18 months, whereas men in BWL lost more weight than those in BWL + H at 18 months. Partners, regardless of gender, lost more weight in BWL + H than BWL at both time points (ps < .0001). Conclusion: The home food and exercise environment is malleable and targeting this microenvironment appears to improve initial weight loss, and in women, 18-month outcomes. Research is needed to understand this gender difference and to develop home-focused strategies with more powerful and sustained weight-loss effects. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Health Psychology 02/2012; · 3.87 Impact Factor
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ABSTRACT: To examine the home environments of overweight and normal-weight adults and the relationships between the environment and weight-regulating behaviors.
Overweight (n=201) and normal-weight adults (n=213) assessed their homes via checklist and self-reported their eating and activity habits.
OW adults had less exercise equipment, fewer low-fat snacks and fruits/vegetables, and more TVs, high-fat snacks, and spreads than did NW adults (Ps<.01). These variables were associated (Ps<.05) with weight-regulating behaviors.
Increasing healthy foods and opportunities for physical activity within the home may improve weight-control efforts in adults.
American journal of health behavior 09/2011; 35(5):618-26. · 1.31 Impact Factor
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ABSTRACT: This study assessed young adults' beliefs about weight gain with the goal of improving intervention efforts with this high-risk group. A total of 1,347 incoming freshman (45% male; 81% non-Hispanic white; 18.6 ± 1.7 years; BMI = 23.3 ± 2.3 kg/m2) at a large state university in the Northeast completed a survey designed to assess: (i) degree of concern about weight gain, (ii) level of interest in weight control programs, and (iii) the most acceptable setting for an intervention. Perceptions about freshman weight gain were consistent across gender, with men and women reporting that the average student gains 5.4 ± 1.9 kg and 5.6 ± 1.9 kg respectively. Men in general were less concerned about weight gain (P < 0.001) and reported they would have to gain 6.2 ± 4.2 kg before becoming concerned compared to 3.1 ± 1.7 kg among women (P < 0.001). Overweight (OW) men were more concerned about gaining weight than normal weight (NW) men (P < 0.001) and indicated they would have to gain less weight before becoming concerned (5.0 ± 3.0 kg vs. 6.7 ± 4.5 kg, P < 0.001). Fewer men reported they would join a program to prevent weight gain (17% men vs. 40% women, P < 0.001); the percentage of men willing to join a prevention program did not vary by weight status (P = 0.59). Both men and women were most likely to report a willingness to attend classes on a local college campus compared to other settings. Findings highlight the challenges of engaging young adults in weight gain prevention programs, particularly young men, and are discussed in terms of implications for improving recruitment efforts and intervention development with this population.
Obesity 07/2011; 19(9):1901-4. · 4.28 Impact Factor
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Rena R Wing,
Delia Smith West,
Deborah Grady,
Jennifer M Creasman,
Holly E Richter,
Deborah Myers, Kathryn L Burgio,
Frank Franklin, Amy A Gorin,
Eric Vittinghoff,
Judith Macer,
John W Kusek,
Leslee L Subak
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ABSTRACT: Initial weight loss improves urinary incontinence in overweight and obese women. In this study we examined the longer term effects of a weight loss intervention on urinary incontinence.
Overweight and obese women (mean +/- SD age 53 +/- 10 years) with 10 or more urinary incontinence episodes weekly were randomized to an 18-month behavioral weight loss intervention (226) or control group (112). Outcome measures were collected at 12 and 18 months.
At baseline women had a mean body mass index of 36 +/- 6 kg/m(2) and reported a mean of 24 +/- 18 incontinence episodes weekly. Of the patients 86% completed 18-month measurements. The percent weight loss in the intervention group averaged 8.0%, 7.5% and 5.5% at 6, 12 and 18 months, respectively, vs approximately 1.5% in the control group (all values p <0.001). Compared with controls at 12 months the intervention group reported a greater percent reduction in weekly stress urinary incontinence episodes (65% vs 47%, p <0.001), and a greater proportion achieved at least a 70% decrease in weekly total and stress urinary incontinence episodes. At 18 months a greater proportion of women in the weight loss intervention group had more than 70% improvement in urge incontinence episodes but there were no significant differences between the groups for stress or total urinary incontinence. The intervention group also reported greater satisfaction with changes in urinary incontinence than the control group at 6, 12 and 18 months.
Weight loss intervention reduced the frequency of stress incontinence episodes through 12 months and improved patient satisfaction with changes in incontinence through 18 months. Improving weight loss maintenance may provide longer term benefits for urinary incontinence.
The Journal of urology 09/2010; 184(3):1005-10. · 4.02 Impact Factor
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Rena R Wing,
Jennifer M Creasman,
Delia Smith West,
Holly E Richter,
Deborah Myers, Kathryn L Burgio,
Frank Franklin, Amy A Gorin,
Eric Vittinghoff,
Judith Macer,
John W Kusek,
Leslee L Subak
[show abstract]
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ABSTRACT: To examine the relationship between magnitude of weight loss and changes in urinary incontinence frequency.
Overweight and obese women (N=338) with 10 or more urinary incontinence episodes per week were assigned randomly to an intensive 6-month behavioral weight loss program followed immediately by a 12-month weight maintenance program (intervention; n=226) or to a structured education program (control; n=112). The intervention and control groups were combined to examine the effects of the magnitude of weight loss on changes in urinary incontinence assessed by 7-day voiding diary, pad test, and self-reported satisfaction with change in urinary incontinence.
Compared with participants who gained weight (reference), those who lost 5% to less than 10% or 10% or more of their body weight had significantly greater percent reductions in urinary incontinence episodes and were more likely to achieve at least a 70% reduction in the frequency of total and urge urinary incontinence episodes at 6, 12, and 18 months. Satisfaction was also related to magnitude of weight loss; approximately 75% of women who lost 5% to less than 10% of their body weight reported being moderately or very satisfied with their changes in urine leakage.
Weight losses between 5% and 10% of body weight were sufficient for significant urinary incontinence benefits. Thus, weight loss should be considered as initial treatment for incontinence in overweight and obese women.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00091988.
II.
Obstetrics and Gynecology 08/2010; 116(2 Pt 1):284-92. · 4.73 Impact Factor
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ABSTRACT: Weight gain in young adults is an important public health problem and few interventions have been successful.
This pilot study evaluated the preliminary efficacy of two self-regulation approaches to weight-gain prevention: Small Changes (changes in energy balance of roughly 200 kcal/day) and Large Changes (initial weight loss of 5-10 lbs to buffer against future weight gains).
Participants were enrolled in 8-week programs teaching Small or Large Changes (SC; LC). Both approaches were presented in a self-regulation framework, emphasizing daily self-weighing.
Randomized controlled pilot study.
Young adults (N=52) aged 18-35 years (25.6+/-4.7 years, BMI of 26.7+/-2.4 kg/m(2)) were recruited in Providence RI and Chapel Hill NC.
Adherence to intervention, weight change, and satisfaction/confidence in approach assessed at 0, 8, and 16 weeks. Data were collected in 2008 and analyzed in 2008-2009.
Participants attended 84% of sessions, and 86.5% and 84.5% of participants completed post-treatment and follow-up assessments, respectively. Participants adhered to their prescriptions. Daily weighing increased markedly in both groups, whereas the eating and exercise changes observed in the SC and LC reflected the specific approach taught. Weight changes were significantly different between groups at 8 weeks (SC= -0.68+/-1.5 kg, LC= -3.2+/-2.5 kg, p<0.001) and 16 weeks (SC= -1.5+/-1.8 kg, LC= -3.5+/-3.1 kg, p=0.006). Participants in both groups reported high levels of satisfaction and confidence in the efficacy of the approach they were taught.
Both Small and Large Change approaches hold promise for weight-gain prevention in young adults; a fully powered trial comparing the long-term efficacy of these approaches is warranted.
American journal of preventive medicine 07/2010; 39(1):63-8. · 4.24 Impact Factor
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Suzanne Phelan,
Alka M Kanaya,
Leslee L Subak,
Patricia E Hogan,
Mark A Espeland,
Rena R Wing, Kathryn L Burgio,
Vicki Dilillo, Amy A Gorin,
Delia S West,
Jeanette S Brown
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ABSTRACT: OBJECTIVE To determine the prevalence and risk factors for urinary incontinence among different racial/ethnic groups of overweight and obese women with type 2 diabetes. RESEARCH DESIGN AND METHODS Cross-sectional analysis of baseline data from the Action for Health in Diabetes (Look AHEAD) study, a randomized clinical trial with 2,994 overweight/obese women with type 2 diabetes. RESULTS Weekly incontinence (27%) was reported more often than other diabetes-associated complications, including retinopathy (7.5%), microalbuminuria (2.2%), and neuropathy (1.5%). The prevalence of weekly incontinence was highest among non-Hispanic whites (32%) and lowest among African Americans (18%), and Asians (12%) (P < 0.001). Asian and African American women had lower odds of weekly incontinence compared with non-Hispanic whites (75 and 55% lower, respectively; P < 0.001). Women with a BMI of > or =35 kg/m(2) had a higher odds of overall and stress incontinence (55-85% higher; P < 0.03) compared with that for nonobese women. Risk factors for overall incontinence, as well as for stress and urgency incontinence, included prior hysterectomy (40-80% increased risk; P < 0.01) and urinary tract infection in the prior year (55-90% increased risk; P < 0.001). CONCLUSIONS Among overweight and obese women with type 2 diabetes, urinary incontinence is highly prevalent and far exceeds the prevalence of other diabetes complications. Racial/ethnic differences in incontinence prevalence are similar to those in women without diabetes, affecting non-Hispanic whites more than Asians and African Americans. Increasing obesity (BMI > or =35 kg/m(2)) was the strongest modifiable risk factor for overall incontinence and stress incontinence in this diverse cohort.
Diabetes care 06/2009; 32(8):1391-7. · 8.09 Impact Factor
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Amy A Gorin,
Heather M Niemeier,
Patricia Hogan,
Mace Coday,
Cralen Davis,
Vicki G DiLillo,
Marci E Gluck,
Thomas A Wadden,
Delia S West,
Donald Williamson,
Susan Z Yanovski
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ABSTRACT: Binge eating (BE) is common in overweight and obese individuals with type 2 diabetes mellitus, but little is known about how BE affects weight loss in this population.
To determine whether BE was related to 1-year weight losses in overweight and obese individuals with type 2 diabetes participating in an ongoing clinical trial.
The Look AHEAD (Action for Health in Diabetes) trial is a randomized controlled trial examining the long-term effect of intentional weight loss on cardiovascular disease in overweight and obese adults with type 2 diabetes. A total of 5145 overweight and obese individuals aged 45 to 76 years with type 2 diabetes participated in this study.
Participants were randomly assigned to an intensive lifestyle intervention or to enhanced usual care (a diabetes support and education control condition).
At baseline and 1 year, participants had their weight measured and completed a fitness test and self-report measures of BE and dietary intake. Four groups were created based on BE status at baseline and 1 year (yes/yes, no/no, yes/no, and no/yes). Analyses controlled for baseline differences between binge eaters and non-binge eaters.
Most individuals (85.4%) did not report BE at baseline or 1 year (no/no), 7.5% reported BE only at baseline (yes/no), 3.7% reported BE at both times (yes/yes), and 3.4% reported BE only at 1 year (no/yes), with no differences between intensive lifestyle intervention and diabetes support and education conditions (P = .14). Across intensive lifestyle intervention and diabetes support and education, greater weight losses were observed in participants who stopped BE at 1 year (mean [SE] weight loss, 5.3 [0.4] kg) and those who reported no BE at either time (mean [SE] weight loss, 4.8 [0.1] kg) than in those who continued BE (mean [SE] weight loss, 3.1 [0.6] kg) and those who began BE at 1 year (mean [SE] weight loss, 3.0 [0.6] kg) (P < .001). Post hoc analyses suggested that these differences were due to changes in caloric intake.
Overweight and obese individuals with type 2 diabetes who stop BE appear to be just as successful at weight loss as non-binge eaters after 1 year of treatment.
clinicaltrials.gov Identifier: NCT00017953.
Archives of general psychiatry 01/2009; 65(12):1447-55. · 12.26 Impact Factor
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ABSTRACT: Few studies have examined predictors of weight regain after significant weight losses. This prospective study examined behavioral and psychological predictors of weight regain in 261 successful weight losers who completed an 18-month trial of weight regain prevention that compared a control condition with self-regulation interventions delivered face-to-face or via the Internet. Linear mixed effect models were used to examine behavioral and psychological predictors of weight regain, both as main effects and as interactions with treatment group. Decreases in physical activity were related to weight regain across all 3 groups, and increased frequency of self-weighing was equally protective in the 2 intervention groups but not in the control group. Increases in depressive symptoms, disinhibition, and hunger were also related to weight regain in all groups. Although the impact of changes in restraint was greatest in the Internet group and weakest in the face-to-face group, the latter was the only group with increases in restraint over time and consequent decreases in magnitude of weight regain. Future programs should focus on maintaining physical activity, dietary restraints, and frequent self-weighing and should include stronger components to modify psychological parameters.
Journal of Consulting and Clinical Psychology 01/2009; 76(6):1015-21. · 4.85 Impact Factor
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ABSTRACT: Given the epidemic of obesity, approaches to weight loss that can be applied on a community, state, or national level are needed. We report results from Shape Up Rhode Island 2007 (SURI), a statewide Internet-based program involving team-based competition to increase physical activity and achieve weight loss. A total of 4,717 adults (84% women; mean BMI = 29.6 kg/m(2)) enrolled in the 16-week weight loss competition of SURI and 3,311 completed at least 12 weeks. Completers reported losing 3.2 +/- 3.4 kg, and 30% achieved a clinically significant weight loss of >or=5%. Although modest, these weight losses shifted the BMI distribution from a mean BMI of 29.4 to a mean of 28.2 kg/m(2) and reduced the population that was obese from 39 to 31%. More conservative intent-to-treat analyses and analysis of 132 participants with objective weights still showed a significant reduction in BMI of -0.8 units. These findings suggest that statewide weight loss campaigns can produce modest weight losses in large numbers of participants. These data provide a benchmark that can be used for comparisons with other statewide campaigns. Research on ways to improve such campaigns is needed.
Obesity 01/2009; 17(5):991-5. · 4.28 Impact Factor
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Leslee L Subak,
Rena Wing,
Delia Smith West,
Frank Franklin,
Eric Vittinghoff,
Jennifer M Creasman,
Holly E Richter,
Deborah Myers, Kathryn L Burgio, Amy A Gorin,
Judith Macer,
John W Kusek,
Deborah Grady
[show abstract]
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ABSTRACT: Obesity is an established and modifiable risk factor for urinary incontinence, but conclusive evidence for a beneficial effect of weight loss on urinary incontinence is lacking.
We randomly assigned 338 overweight and obese women with at least 10 urinary-incontinence episodes per week to an intensive 6-month weight-loss program that included diet, exercise, and behavior modification (226 patients) or to a structured education program (112 patients).
The mean (+/-SD) age of the participants was 53+/-11 years. The body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) and the weekly number of incontinence episodes as recorded in a 7-day diary of voiding were similar in the intervention group and the control group at baseline (BMI, 36+/-6 and 36+/-5, respectively; incontinence episodes, 24+/-18 and 24+/-16, respectively). The women in the intervention group had a mean weight loss of 8.0% (7.8 kg), as compared with 1.6% (1.5 kg) in the control group (P<0.001). After 6 months, the mean weekly number of incontinence episodes decreased by 47% in the intervention group, as compared with 28% in the control group (P=0.01). As compared with the control group, the intervention group had a greater decrease in the frequency of stress-incontinence episodes (P=0.02), but not of urge-incontinence episodes (P=0.14). A higher proportion of the intervention group than of the control group had a clinically relevant reduction of 70% or more in the frequency of all incontinence episodes (P<0.001), stress-incontinence episodes (P=0.009), and urge-incontinence episodes (P=0.04).
A 6-month behavioral intervention targeting weight loss reduced the frequency of self-reported urinary-incontinence episodes among overweight and obese women as compared with a control group. A decrease in urinary incontinence may be another benefit among the extensive health improvements associated with moderate weight reduction. (ClinicalTrials.gov number, NCT00091988.)
New England Journal of Medicine 01/2009; 360(5):481-90. · 53.30 Impact Factor
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ABSTRACT: The rates of childhood obesity continue to rise, with poor dietary habits and sedentary lifestyles as the most proximal causes.
Historically, researchers have focused on individual-level variables such as health-related know-ledge, motivation, and self-efficacy
to understand eating, exercise, and obesity. This approach is limited in that internal psychological characteristics are often
poor predictors of weight-regulating behaviors (Strauss, Rodzilsky, Burack, & Colin, 2001; Timperio et al. 2006) and behavioral
weight loss treatment focused on the obese patient alone has struggled to produce long-term weight control (Epstein, Myers,
Raynor, & Saelens, 1998). Moreover, this individual-level approach fails to address how the numerous societal trends observed
over the past 30 years—such as the proliferation of fast food restaurants and increased access to television—influence the
weight of children. Researchers have recently begun to approach obesity from an ecological perspective, revealing several
environmental correlations between unhealthy eating, sedentary lifestyles, and obesity (French, Story, & Jeffery, 2001; Hill
& Peters, 1998; Nestle & Jacobson, 2000), leading many to conclude that for obesity, “genetics loads the gun, [but] the environment
pulls the trigger” (Bray, 1996).
12/2008: pages 145-161;
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ABSTRACT: This study examined the relation between method of weight loss and long-term maintenance among successful weight losers enrolled in a weight-loss maintenance trial. Participants were 186 adults (mean age = 51.6 +/- 10.7 years, mean BMI = 28.6 +/- 4.7 kg/m(2)) enrolled in the STOP Regain trial who had lost at least 10% of their body weight in the past 2 years using a very low-calorie diet (VLCD; n = 24), commercial program (n = 95), or self-guided approach (n = 67). Participants were randomized to a weight-maintenance intervention delivered face to face or over the internet or to a newsletter control condition, and followed for 18 months. At study entry, individuals who had used a VLCD had achieved a weight loss of 24% of their maximum weight within the past 2 years compared to 17% achieved by those who had used a commercial program or self-guided approach (P < 0.001). However, individuals who had used a VLCD regained significantly more weight than the other two groups and by 6 months, there were no significant differences in overall percent weight loss (i.e., initial weight loss and maintenance) between VLCD, commercial, and self-guided methods. In contrast, individuals who had used a self-guided approach maintained their weight losses from baseline through 18 months. The large initial weight losses achieved by individuals who had used a VLCD were not maintained over time, whereas individuals who had used a self-guided approach maintained their initial weight losses with the greatest success. The generalizability of these findings is limited by the sizeable weight losses achieved by study participants.
Obesity 09/2008; 16(11):2456-61. · 4.28 Impact Factor
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ABSTRACT: The objective was to examine whether having a weight loss experience that lives up to one's expectations is related to maintenance in a group of successful weight losers participating in the STOP Regain trial.
Participants (N = 314, 81% women, mean age, 51.3 +/- 10.1 years; BMI = 28.6 +/- 4.8 kg/m2) who lost >or=10% of their body weight within the past 2 years were randomly assigned to a maintenance program delivered either face-to-face or via the Internet or to a control group and assessed at 0, 6, 12, and 18 months.
At study entry, participants had lost 19% of their body weight, yet 86% of participants were currently trying to lose more weight. Further losses of 13% of body weight were needed to reach self-selected ideal weights, with heavier participants wanting to lose more (p < 0.001). The weight loss-related benefits participants achieved did not live up to their expectations (p <or= 0.01). However, neither satisfaction with current weight, nor amount of further weight loss desired, nor discrepancies between actual and expected benefits predicted regain after adjusting for treatment group, gender, baseline weight, and percent weight loss before entry.
Even among very successful weight losers, expectations were not met and substantial further weight losses were desired; however, these factors were not related to subsequent weight maintenance outcomes.
Obesity 12/2007; 15(12):3086-90. · 4.28 Impact Factor
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ABSTRACT: Several recent studies suggest that daily weighing is important for long-term weight control, but concerns have been raised about possible adverse psychological effects. The "STOP Regain" clinical trial provides a unique opportunity to examine this issue both cross-sectionally and prospectively. Successful weight losers (N = 314) were randomly assigned to a control or to a face-to-face or Internet intervention designed to help them maintain their weight loss and were then followed for 18 months. The intervention groups reported increases in daily self-weighing, which were associated with successful weight loss maintenance. We found no evidence that increases in frequency of weighing or daily weighing per se had any adverse effects in this study population. Rather, increases in self-weighing were associated with increases in dietary restraint (p < .001), decreases in disinhibition (p < .003), and decreases in depressive symptoms (p < .002). Moreover, those who weighed daily at 18 months were less likely to report having >or=4 binge episodes per month (p = .03). Daily weighing appears to be an important aspect of weight loss maintenance and was not associated with adverse psychological effects.
Journal of Consulting and Clinical Psychology 08/2007; 75(4):652-6. · 4.85 Impact Factor
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ABSTRACT: Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service.
Overweight participants (N = 28; BMI = 31.7 +/- 3.6 kg/m2; 89.3% women, 47.9 +/- 9.5 years) were randomly assigned to 8-weeks of standard behavioral weight loss (SBT) or to SBT plus home food delivery (SBT+Home). SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges.
Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p = .01) and number of foods that were high in fat (p = .002). While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p = .08). Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study.
Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes.
International Journal of Behavioral Nutrition and Physical Activity 02/2007; 4:58. · 3.83 Impact Factor
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ABSTRACT: Since many successful dieters regain the weight they lose, programs that teach maintenance skills are needed. We developed a maintenance program based on self-regulation theory and tested the efficacy of delivering the program face to face or over the Internet.
We randomly assigned 314 participants who had lost a mean of 19.3 kg of body weight in the previous 2 years to one of three groups: a control group, which received quarterly newsletters (105 participants), a group that received face-to-face intervention (105), and a group that received Internet-based intervention (104). The content of the programs in the two intervention groups was the same, emphasizing daily self-weighing and self-regulation, as was the frequency of contact with the groups. The primary outcome was weight gain over a period of 18 months.
The mean (+/-SD) weight gain was 2.5+/-6.7 kg in the face-to-face group, 4.7+/-8.6 kg in the Internet group, and 4.9+/-6.5 kg in the control group, with a significant difference between the face-to-face group and the control group (2.4 kg; 95% confidence interval [CI], 0.002 to 10.8; P=0.05). The proportion of participants who regained 2.3 kg or more over the 18-month period was significantly higher in the control group (72.4%) than in the face-to-face group (45.7%; absolute difference, 27%; 95% CI, 14 to 39; P<0.001) or the Internet group (54.8%; absolute difference, 18%; 95% CI, 5 to 30; P=0.008). Daily self-weighing increased in both intervention groups and was associated with a decreased risk of regaining 2.3 kg or more (P<0.001).
As compared with receiving quarterly newsletters, a self-regulation program based on daily weighing improved maintenance of weight loss, particularly when delivered face to face. (ClinicalTrials.gov number, NCT00067145 [ClinicalTrials.gov].)
New England Journal of Medicine 11/2006; 355(15):1563-71. · 53.30 Impact Factor
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ABSTRACT: Medical events are often reported as triggers for weight loss, but it is unknown whether medical triggers result in better short- and long-term weight control.
The relationship between medical triggers and weight loss was examined in the National Weight Control Registry (NWCR), a database of individuals who have lost > or =30 lbs and kept it off for > or =1 year. Recall of weight loss triggers may become difficult over time, thus participants were limited to those reporting weight loss <5 years ago. Three groups were examined: (1) participants with medical triggers (N = 207), (2) participants with nonmedical triggers (N = 539), and (3) participants with no trigger (N = 171).
Participants with medical triggers were older than those with nonmedical triggers or no trigger (50.5 +/- 11.7, 44.9 +/- 11.8, 46.7 +/- 13.3 years; P = 0.0001), had a higher initial BMI at entry into the NWCR (26.1 +/- 5.0, 25.0 +/- 4.3, 24.8 +/- 4.4 kg/m2; P = 0.004), and were more likely to be male (37.1%, 18%, 17.2%; P = 0.0001). Participants with medical triggers reported greater initial weight loss than those with nonmedical triggers or no trigger (36.5 +/- 25.0, 31.8 +/- 16.6, 31.8 +/- 17.1 kg; P = 0.01). Participants with medical triggers also gained less weight over 2 years of follow-up than those with nonmedical triggers or no trigger (P = 0.003).
Medical triggers may produce a teachable moment for weight control, resulting in better initial weight loss and long-term maintenance.
Preventive Medicine 09/2004; 39(3):612-6. · 3.22 Impact Factor
