Nangel M Lindberg

Kaiser Permanente, Oakland, California, United States

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Publications (18)26.19 Total impact

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    ABSTRACT: The LIFE study was a randomized controlled trial assessing the impact of a self-acupressure intervention, Tapas Acupressure Technique® (TAT®), on weight-loss maintenance. The primary analysis showed no significant difference between TAT and social support (SS) for weight-loss maintenance, while exploratory post hoc tests suggested that, among participants with highest initial weight-loss, those in the TAT condition regained less weight than those in the SS condition. The aim of the current study was to assess adherence to, and satisfaction with, the experimental self-acupressure intervention in the LIFE weight loss maintenance trial. This was a secondary analysis of adherence and satisfaction patterns in a large randomized controlled trial. The study was conducted at a prominent health maintenance organization in the Pacific Northwest. This study involved 142 obese participants who had lost >10 pounds in a conventional weight-loss program and who were randomized to the experimental acupressure intervention. The experimental intervention (n=142) arm consisted of instruction and application of a self-acupressure intervention, the Tapas Acupressure Technique(®) (TAT(®)). The outcome sought was self-reported satisfaction and frequency of TAT practice. Sixty-six percent of TAT participants attended at least 6 of 8 intervention sessions. More than 80% of participants reported practicing TAT at home, on average, at least 2 days per week. Sixty two percent reported practicing <10 minutes per session, while 27% reported practicing 10-20 minutes per session. Higher satisfaction scores were significantly correlated with less weight regain (p=0.001). Frequency of TAT practice was not significantly associated with changes in weight, stress, insomnia, depression, or quality of life. These data suggest moderate acceptance of, and adherence to, the TAT intervention. Further research is required to identify and achieve optimal home-practice levels of self-acupressure techniques.
    Medical Acupuncture 02/2013; 25(1):43-47.
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    Nangel M Lindberg, Victor J Stevens, Ruben O Halperin
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    ABSTRACT: In the United States, ethnic minorities are overrepresented among the overweight and obese population, with Hispanic individuals being among the groups most at risk for obesity and obesity-related disease and disability. Most weight-loss interventions designed for the general population have been less successful with individuals from ethnic minorities and there is a pressing need to develop more effective interventions for these groups. This paper examines the importance of culture in the development of "culturally competent" weight-loss interventions for ethnic minority populations, and discusses specific culturally mediated factors that should be considered in the design and implementation of treatment interventions. While specifically focusing on Hispanic populations, we also address issues of relevance to other multiethnic societies.
    Journal of obesity 01/2013; 2013:542736.
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    ABSTRACT: Background/Aims Mexican-American women are at particularly high risk for obesity and associated comorbidities. This pilot study tested the feasibility of a culturally-tailored weight-loss intervention aimed at obese Spanish-speaking Mexican-American women. Methods The intervention consisted of 6 months of weekly sessions followed by 6 monthly sessions. All sessions were 90-minutes long and conducted in group format, in Spanish. Cultural adaptations included: women only groups, minimum of written materials, focus on Mexican traditions and health beliefs, intensive skill-building tasks around food measurement. This study had a truly open-door policy, with a minimum criteria for inclusion that did not screen out individuals generally considered poor candidates for retention in research studies. Results Recruitment exceeded expectations, with 47 participants enrolling in the study. Mean weight loss at 6 and 12 months was 5.3 and 7.1 kg, with a mean reduction in BMI of 2.8 at 12 months. At 6 months, there was a significant reduction from baseline levels in total daily energy intake (mean reduction = 899 kcal), percentage of calories from fat (mean reduction 5.4%), and total sugar intake (mean reduction 29%). There were significant increases in percent of calories from protein and number of vegetable servings. Discussion It is feasible to implement culturally appropriate behavioral interventions for obesity treatment. Our experience suggests the need to implement culturally sensitive intervention formats and alternative gold standards for retention success in "real life" settings with minority populations. Potential directions and options for dissemination of this intervention program will be discussed.
    Clinical Medicine &amp Research 08/2012; 10(3):144.
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    ABSTRACT: The objective of this study is to examine the use of complementary and alternative medicine (CAM) for weight loss among Mexican-American women. Cross-sectional survey of different CAM modalities, including traditional Mexican medicine therapies. The sample was drawn from women participating in a weight-loss program in Portland, Oregon. Sample consisted of 31 adult Mexican-American women. Most respondents reported using some form of CAM for weight loss, with most reporting using herbs and teas (70 %), home remedies (61 %) and massage (55 %). Mexican-American women report using a wide range of CAM therapies for weight loss. Understanding their patterns of use will enhance cultural competence of health care professionals and help address their medical needs.
    Journal of Immigrant and Minority Health 07/2012; · 1.16 Impact Factor
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    BMC Complementary and Alternative Medicine 06/2012; 12(1). · 2.08 Impact Factor
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    ABSTRACT: This study assessed the feasibility of a culturally-appropriate weight-loss intervention targeting obese Spanish-speaking Mexican women. This 12-month weight-loss program was based on behavioral interventions previously used successfully with English-speaking participants. Cultural adaptations included: female interventionists, minimal written materials, emphasis on group activities, focus on Mexican traditions and beliefs, and skill-building approach to food measurement. All sessions were conducted in Spanish. The study had few exclusionary criteria, which allowed participation of women with a wide range of literacy levels. Recruitment exceeded expectations, with 47 participants enrolling in the program. Not counting participants who became pregnant during the study, attendance at 6 and 12 months was 62 and 50 % respectively. Mean weight loss at 6 and 12 months was 5.3 and 7.2 kg, respectively, with a mean reduction in BMI of 4.0 and 5.5 kg/m(2) from baseline to 6 and 12 months, respectively. This pilot study shows that it is feasible to develop and implement culturally-appropriate behavioral lifestyle interventions for obesity treatment in Mexican-American women.
    Journal of Immigrant and Minority Health 03/2012; · 1.16 Impact Factor
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    ABSTRACT: Obesity is an urgent public health problem, yet only a few clinical trials have systematically tested the efficacy of long-term weight-loss maintenance interventions. This randomized clinical trial tested the efficacy of a novel mind and body technique for weight-loss maintenance. Participants were obese adults who had completed a six-month behavioral weight-loss program prior to randomization. Those who successfully lost weight were randomized into either an experimental weight-loss maintenance intervention, Tapas Acupressure Technique (TAT®), or a control intervention comprised of social-support group meetings (SS) led by professional facilitators. TAT combines self-applied light pressure to specific acupressure points accompanied by a prescribed sequence of mental steps. Participants in both maintenance conditions attended eight group sessions over six months of active weight loss maintenance intervention, followed by an additional 6 months of no intervention. The main outcome measure was change in weight from the beginning of the weight loss maintenance intervention to 12 months later. Secondary outcomes were change in depression, stress, insomnia, and quality of life. We used analysis of covariance as the primary analysis method. Missing values were replaced using multiple imputation. Among 285 randomized participants, 79% were female, mean age was 56 (standard deviation (sd) = 11), mean BMI at randomization was 34 (sd = 5), and mean initial weight loss was 9.8 kg (sd = 5). In the primary outcome model, there was no significant difference in weight regain between the two arms (1.72 kg (se 0.85) weight regain for TAT and 2.96 kg (se 0.96) weight regain for SS, p < 0.097) Tests of between- arm differences for secondary outcomes were also not significant. A secondary analysis showed a significant interaction between treatment and initial weight loss (p < .036), with exploratory post hoc tests showing that greater initial weight loss was associated with more weight regain for SS but less weight regain for TAT. The primary analysis showed no significant difference in weight regain between TAT and SS, while secondary and post hoc analyses indicate direction for future research.
    BMC Complementary and Alternative Medicine 03/2012; 12:19. · 2.08 Impact Factor
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    ABSTRACT: Traditional recruitment methods for clinical trials, such as telephone, mail, and print media, are often inefficient, costly, and use large amounts of staff time and resources. This analysis was conducted to determine whether retention, demographics, and outcomes differed between enrolled participants who responded to recruitment outreach using an Internet-based information and registration system and enrollees whose first contact was with study staff via telephone. We identified potentially eligible participants from Kaiser Permanente Northwest (KPNW) databases and mailed brochures inviting them to participate in the Life weight loss maintenance study. We also used employee newsletters, a member-directed website, and messages to employee email distribution lists to publicize the study. All outreach methods contained both a website address and a telephone number through which respondents could register for an information session. The website contained the same information as was provided by staff over the telephone. Out of 2122 potential participants who expressed interest in the study, 70% did so through the website. There was no difference in retention rates between enrollees who initiated contact through the website (WEB = 308) and enrollees who contacted the study by telephone (staff = 161). The WEB group was younger (p = 0.01), had higher income (p = 0.01) and education (p < 0.01) levels, and lower body mass index (BMI; p < 0.01). There was a trend toward greater weight loss in the WEB group (p = 0.06). We did not conduct a formal cost analysis of the two methods. Also, the population for this analysis was mostly Caucasian and middle income; thus, we cannot draw conclusions about the generalizability of our findings to more racially and economically diverse populations. Enrolled participants who used a website to register for an initial study information session had similar study retention and outcome performance as enrollees who used a more traditional telephone method. For larger clinical trials, a website may help researchers more efficiently and cost-effectively achieve recruitment, eligibility, and randomization goals. More research is needed to determine whether similar recruitment and retention patterns are observed among racially and economically diverse populations when these and similar methods are compared.
    Clinical Trials 01/2012; 9(2):226-31. · 2.20 Impact Factor
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    ABSTRACT: Background In the USA, 77% of Hispanic women age 20 and older are classified as overweight or obese. There is evidence that Hispanics tend to be less successful than non-Hispanic whites in standard weight-loss interventions. This study assessed the feasibility of a culturally-tailored behavioral weight-loss intervention specifically designed for Spanish-speaking women of Mexican origin. Methods This 6-month intervention consisting of weekly sessions was based on approaches previously used successfully with English-speaking participants in the PREMIER and Weight Loss Maintenance trials. Cultural adaptations were implemented throughout the program based on information derived from focus groups, available literature, and a multidisciplinary team that included Mexican experts in behavioral interventions and nutritional anthropology. The intervention was conducted entirely in Spanish. Beyond language, specific cultural adaptations included: "Grupos de mujeres" ("women-only" groups) of a wide range of age-covering topics central to the immigration experience (e.g., the loss of social networks, differing body-shape ideals in Mexican and American cultures, and the pressure of maintaining Mexican traditions while adopting "American ways"). Focusing on staple foods in the Mexican diet: returning to a traditional diet, how to make healthy choices. Providing basic instruction on nutrition, and hands-on training on standard food measurement for portion control. Addressing Mexican folk remedies and traditional beliefs regarding food and diet (e.g. "hot" and "cold" foods, "empacho," etc.). Developing food-intake journals for people of limited literacy. Results The recruitment strategies used resulted in a significantly larger-than-expected response. There were 47 participants in the study. Thirty-one participants completed the intervention and had main outcome data available. Participants did not complete the intervention because they became pregnant (2), had unexpected changes in school schedules (2), relocated to Mexico due to immigration problems (3), needed to follow agricultural work (6), unknown reasons (3). After 6 months, average weight decreased by 7.26 kg (16 lb), p< .0001. Conclusions Mexican-American women have previously been underrepresented in weight-loss interventions; however, this study suggests that culturally-congruent recruitment methods can successfully attract this population to lifestyle intervention programs, and that carefully-tailored culturally adapted weight-loss interventions are feasible and potentially effective among Spanish-speaking Mexican-American women.
    Clinical Medicine &amp Research 11/2011; 9(3-4):166.
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    ABSTRACT: The LIFE study is a two-phase randomized clinical trial comparing two approaches to maintaining weight loss following guided weight loss. Phase I provided a nonrandomized intensive 6-month behavioral weight loss intervention to 472 obese (body mass index 30-50) adult participants. Phase II is the randomized weight loss maintenance portion of the study. This paper focuses on Phase I measures of sleep, screen time, depression and stress. The Phase I intervention consisted of 22 group sessions led over 26 weeks by behavioral counselors. Recommendations included reducing dietary intake by 500 calories per day, adopting the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and increasing physical exercise to at least 180 min per week. Measures reported here are sleep time, insomnia, screen time, depression and stress at entry and post-weight loss intervention follow-up. The mean weight loss for all participants over the intensive Phase I weight loss intervention was 6.3 kg (s.d. 7.1). Sixty percent (N=285) of participants lost at least 4.5 kg (10 lbs) and were randomized into Phase II. Participants (N=472) attended a mean of 73.1% (s.d. 26.7) of sessions, completed 5.1 (s.d. 1.9) daily food records/week, and reported 195.1 min (s.d. 123.1) of exercise per week. Using logistic regression, sleep time (quadratic trend, P=0.030) and lower stress (P=0.024) at entry predicted success in the weight loss program, and lower stress predicted greater weight loss during Phase I (P=0.021). In addition, weight loss was significantly correlated with declines in stress (P=0.048) and depression (P=0.035). Results suggest that clinicians and investigators might consider targeting sleep, depression and stress as part of a behavioral weight loss intervention.
    International journal of obesity (2005) 03/2011; 36(1):86-92. · 5.22 Impact Factor
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    ABSTRACT: The aim of this article is to present the rationale, study design, and methods of an ongoing randomized controlled trial assessing the efficacy of an energy psychology intervention, Tapas Acupressure Technique (TAT), to prevent weight regain following successful weight loss. This is a randomized controlled trial. The study is being conducted at a large group-model health maintenance organization (HMO). The study subjects are adult members of an HMO. TAT is being compared to a self-directed social support comparison intervention. The primary outcome measure is weight-loss maintenance at 6 and 12 months post-randomization. This randomized controlled trial will test the efficacy of an energy psychology intervention, TAT, by comparing it with a self-directed social support group intervention. This is, to our knowledge, the largest randomized controlled study to date of an energy psychology intervention. Positive findings would support the use of TAT as a tool to prevent weight regain following successful weight loss.
    Journal of alternative and complementary medicine (New York, N.Y.) 06/2010; 16(6):683-90. · 1.69 Impact Factor
  • Nangel M Lindberg, Victor J Stevens
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    ABSTRACT: There is an urgent need for effective and accessible culturally-sensitive weight-loss interventions for the Mexican-American population. It is imperative that cultural factors be taken into account when designing weight-loss interventions targeting this population. As a first step in this direction, this study examined the experiences, concerns, and beliefs regarding diet, weight and weight loss of Mexican-American immigrant women. Focus groups were conducted with Mexican-American women (n = 25) between the ages of 20 and 63, from the Portland, Oregon metropolitan area. Major themes identified in the discussions included important lifestyle changes brought about by immigration, the challenges of adopting "American ways," lack of nutritional information, and the difficulties in making food choices given the complexities of the family context. Behavioral interventions must provide culturally-centered behavioral strategies addressing some of the difficulties identified in this study. Specific suggestions are provided for the development of weight-loss interventions for this population.
    Journal of Immigrant and Minority Health 10/2009; 13(1):155-60. · 1.16 Impact Factor
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    ABSTRACT: To assess the efficacy of an intervention designed to increase appropriate use of breast self-examination (BSE). Two-armed randomized clinical trial of cancer-control interventions in women that compared a BSE intervention program to a dietary intervention, which served as the control group. The study was conducted at a large health maintenance organization in Portland, Oregon. Participants were 616 female members of the health maintenance organization who were aged 40 to 70 years. The intervention consisted of a 30- to 45-minute individual counseling session that featured BSE instruction, training and practice with silicone models, identification of barriers to BSE, and problem-solving. This intervention was followed by two brief follow-up telephone calls. The study outcome measure was self-reported BSE practice, which included duration, frequency, and specific elements of exam. The study had a 90% response rate. At the 1-year follow-up, chi2 analyses showed that significantly more individuals in the BSE intervention (59%) reported adequate BSE performance compared with those in the control group (12.2%; p < .001). This brief intervention was successful in encouraging women to perform adequate BSEs. Although the role of the BSE in patient care remains controversial, these results show that even brief intervention programs can be effective at encouraging self-screening for cancer. This intervention could easily be modified to target other screening practices (e.g., skin or testicular cancer screening) that are associated with reduced cancer morbidity and mortality.
    American journal of health promotion: AJHP 01/2009; 23(5):320-3. · 2.37 Impact Factor
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    Nangel M Lindberg, Victor J Stevens
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    ABSTRACT: To conduct a review of published studies that have addressed the effectiveness of weight-loss interventions for Hispanic individuals in the United States, identify key components of effective interventions for this population, and provide a set of recommendations for the development of effective treatment programs. Online bibliographic databases were searched from 1980 to September 2006. STUDY INCLUSION/EXCLUSION CRITERIA: Two key search dimensions ("Latino" or "Mexican-American" or "Hispanic" or "Spanish-speaker"; and "weight-loss" or "weight-reduction" or "obesity treatment" or "diet intervention") were used to search for articles. The methods and findings of all retrieved articles were evaluated, and summary outcome data were taken from published results. The limited number of published articles found, and the lack of identifying information on key variables (eg, manner in which subjects were determined to be "Hispanic," level of acculturation, socioeconomic status [SES], number of years living in the United States, country of origin, etc) precluded conducting a formal meta-analysis on the available outcome data. The review identified only three controlled intervention studies specifically targeting Hispanic populations for weight-loss; most of the available studies were not randomized and did not assess key variables, such as acculturation, type of community of origin, level of education, etc. Most available "culturally sensitive" health-related interventions targeting Hispanic populations do not specify what made the interventions "culturally sensitive" beyond the translation of the materials into Spanish. Traditional weight-loss interventions developed for use on Anglo-American subjects do not appear to have been effective for Hispanic individuals. There is an urgent need to both develop effective interventions and to improve the methodologic thoroughness in the design, implementation, and reporting of such interventions for this population.
    Ethnicity & disease 02/2007; 17(2):397-402. · 1.12 Impact Factor
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    Nangel M Lindberg, Victor J Stevens
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    ABSTRACT: El presente estudio examinó diversos factores psicosociales asociados con niveles elevados de sintomatología depresiva en mujeres con antecedentes familiares de cáncer de mama que asistían a una clínica de alto riesgo. Se encontró una asociación positiva entre la sintomatología depresiva y el tener más familiares diagnosticados con la enfermedad, no estar involucrada la paciente en una relación de pareja, y no tener hijos. La ansiedad experimentada por las participantes al seguir recomendaciones médicas de pruebas de detección de cáncer fue significativamente mayor para quienes presentaban sintomatología depresiva elevada, particularmente en lo referente a los autoexámenes de mama. Dada la evidencia de que el autoexamen de mama no se encuentra asociado con reducciones en mortalidad por cáncer, parece recomendable que los clínicos que atienden a pacientes en riesgo no den mucha importancia a esta prueba, y enfaticen en cambio el diagnóstico y tratamiento de síntomas de depresión y ansiedad que conllevan el potencial de interferir con los comportamientos de cuidado de la salud en estas poblaciones de riesgo.
    Psicología y Salud. 01/2007;
  • N M Lindberg, D Wellisch
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    ABSTRACT: The aim of this study was to investigate the association between symptoms of depression and general anxiety, patient's feelings of vulnerability to cancer, the anxiety experienced specifically in relation to various cancer-screeningprocedures, and compliance with these procedures among women atfamilial risk for breast cancer The data were obtained from 430 patients from the High Risk Clinic at the UCLA Revlon Breast Center who completed the State-Trait Anxiety Inventory and answered questions about their perceived vulnerability to breast cancer; the anxiety they experienced regarding undergoing pap smear tests, mammograms, and breast self-examinations (BSEs); and their compliance with these cancer-screening procedures. Correlations were used to estimate the association between feelings of anxiety and compliance. We found that women attending programs targeting those at familial risk for breast cancer suffer from significant symptoms of general anxiety. General anxiety was found to be related to anxiety regarding specific screening practices but not to women's perceived vulnerability to cancer In general, neither general nor screening-specific anxiety were found to be related to patients 'compliance with screening practices; however, significant associations were found between patient's feelings of anxiety regarding BSEs and their actual performing them. BSE appears to be the only procedure for which compliance is negatively associated with procedure-specific anxiety. We offer possible explanations for this relation and discuss the possible psychological impact that recommendations regarding BSEs may have on highly anxious at-risk women.
    Annals of Behavioral Medicine 02/2001; 23(4):298-303. · 4.20 Impact Factor
  • D K Wellisch, N M Lindberg
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    ABSTRACT: This study examines the difference on several demographic and psychosocial variables between women at high risk for breast cancer above and below the cut-off point of a depression measure (Center for Epidemiological Study Depression Scale). Data are presented for 430 consecutive patients from the UCLA Revlon Breast Center High Risk Clinic. Women scoring above the depression cut-off point were younger, had more relatives with breast cancer, reported more symptoms of anxiety, and had more self-perceived vulnerability to breast cancer. In addition, women above the depression cut-off point were more likely to be single, childless, to have not viewed the results of the surgical treatment of their relative, and to feel more anxiety regarding screening practices (mammography, pap smears, and breast self-examinations).
    Psychosomatics 01/2001; 42(4):330-6. · 1.73 Impact Factor
  • Nangel M. Lindberg, Victor J. Stevens
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    ABSTRACT: This study examined various psychosocial variables associated with elevated symptoms of de- pression among women at risk for familial breast cancer attending a specialty clinic. Having multiple relatives with breast cancer, not being involved in a relationship, and not having chil- dren were among the variables associated with elevations in depressive symptomatology. The anxiety associated with following medical recommendations regarding cancer screening was significantly higher for women with elevated depression scores, particularly in the case of breast self-examination. Given the evidence that this test is not associated with reduced cancer morta- lity, it may be advisable for clinicians to stop recommending this screening, and focus on trea- ting symptoms of depression and anxiety which have the potencial to undermine individuals' health-related behaviors.