Robert Jeffery

Robert Jeffery
University of Minnesota Twin Cities | UMN · Division of Epidemiology and Community Health

PhD

About

373
Publications
59,481
Reads
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36,989
Citations
Citations since 2017
23 Research Items
9860 Citations
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Introduction
Skills and Expertise

Publications

Publications (373)
Article
Objective: Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and diabetes support and education (DSE) (control) in 5,145 individuals with overweight/obesity and type 2 diabetes, found no significant differences in all-cause or cardiovascular mortality or morbidity during 9.6 (median) years of intervention. Participant...
Article
Objective: To conduct post hoc secondary analysis examining the association between change in physical activity. Measured with self-report and accelerometry, from baseline to 1 and 4 years and cardiovascular disease (CVD) outcomes in the Look AHEAD Trial. Research design and methods: Participants were adults with overweight/obesity and type 2 di...
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Background State-of-the-art behavioral weight loss treatment (SBT) can lead to clinically meaningful weight loss, but only 30–60% achieve this goal. Developing adaptive interventions that change based on individual progress could increase the number of people who benefit. Purpose Conduct a Sequential Multiple Assignment Randomized Trial (SMART) to...
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Background: Individuals receiving behavioral weight loss treatment frequently fail to adhere to prescribed dietary and self-monitoring instructions, resulting in weight loss clinicians often needing to assess and intervene in these important weight control behaviors. A significant obstacle to improving adherence is that clinicians and clients some...
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Objective: To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared with standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. Research design and methods: Data were from 4,827 participants during their fir...
Article
Objective This study was designed to determine whether intensive lifestyle intervention (ILI) aimed at weight loss lowers cancer incidence and mortality. Methods Data from the Look AHEAD trial were examined to investigate whether participants randomized to ILI designed for weight loss would have reduced overall cancer incidence, obesity‐related ca...
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Background: The majority of participants in weight loss trials are non-Hispanic White women, while men and women of color are underrepresented. This study presents data obtained from non-targeted and targeted recruitment approaches in a trial of behavioral weight loss programs to (1) describe the yields from each approach and (2) compare the demog...
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The health effects of weight loss in older individuals with diabetes is unclear, perhaps related to intentionality of the weight loss. Look AHEAD (LA) is a randomized trial comparing intensive lifestyle intervention for intentional weight loss with diabetes support and education (control) in 5145 individuals (age 45-76 at baseline) with overweight/...
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Objective This study evaluated weight changes after cessation of the 10‐year intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study. It was hypothesized that ILI participants would be more likely to gain weight during the 2‐year observational period following termination of weight‐loss–maintenance counseling...
Article
Objective: To examine the effects of an intensive lifestyle intervention (ILI) on cardiovascular disease (CVD), the Action for Health in Diabetes (Look AHEAD) trial randomized 5,145 participants with type 2 diabetes and overweight/obesity to a ILI or diabetes support and education. Although the primary outcome did not differ between the groups, th...
Article
Background Pediatric primary care is an important setting for addressing obesity prevention. Objective The Healthy Homes/Healthy Kids 5‐10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent‐targeted phone coaching. Methods Children aged 5 to 10...
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Background: Behavioral interventions to prevent pediatric obesity have shown inconsistent results across the field. Studying what happens within the "black box" of these interventions and how differences in implementation lead to different outcomes will help researchers develop more effective interventions. Aim: To compare the implementation of...
Article
Background Lifestyle interventions to reduce weight and increase activity may preserve higher-order cognitive abilities in overweight/obese adults with type 2 diabetes (T2D). Methods Adults (N=5,084) with T2D who enrolled in a randomized clinical trial of a 10-year intensive lifestyle intervention (ILI) compared with diabetes support and education...
Article
Background: Intensive lifestyle interventions (ILI) to reduce weight and increase physical activity may preserve higher-order cognition in overweight and obese adults with type 2 diabetes (T2D). Methods: Adults with T2D who enrolled in a randomized clinical trial of a 10-year ILI compared with diabetes support and education (DSE; N=5,084; mean age=...
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Objective: Cross-sectional studies suggest an association between weight cycling and psychological status. Although this is often interpreted as suggesting that weight cycles "cause" psychological distress, the relationship could be bidirectional. This study provides a prospective analysis of the bidirectional association between weight variabilit...
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Background Lifestyle interventions have been shown to improve physical function over the short term; however, whether these benefits are sustainable is unknown. The long-term effects of an intensive lifestyle intervention on physical function were assessed using a randomized post-test design in the Look AHEAD trial. Methods Overweight and obese (B...
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Standardized methods are needed to evaluate what occurs within the 'black box' of behavioral interventions to prevent pediatric obesity. The purpose of this research is to evaluate methods to specify the behavior change techniques used and the amount of time spent discussing target weight-related behaviors in an intervention for parents of children...
Article
Intentional weight loss is an important treatment option for overweight persons with type 2 diabetes mellitus (DM), but the effects on long term fracture risk are not known. The purpose of this Look AHEAD analysis was to evaluate whether long term intentional weight loss would increase fracture risk in overweight or obese persons with DM. Look AHEA...
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Background: There is value in having parents choose which behaviors to address in obesity interventions, but it is unknown whether they choose behaviors that will effectively impact healthy growth. This study assessed whether child behaviors or parent intention to change behaviors were associated with behaviors parents chose to discuss. Methods:...
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Background: The purpose of this study is to compare effects of different nations on Roux-en-Y gastric bypass (RYGB) vs. intensive medical management (IMM) in achieving remission of type 2 diabetes mellitus (T2DM). Materials and methods: Between April 2008 and December 2011, this randomized, controlled clinical trial was conducted at four teachin...
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Objective: To assess whether an average of 10 years of lifestyle intervention designed to reduce weight and increase physical activity lowers the prevalence of cognitive impairment among adults at increased risk due to type 2 diabetes and obesity or overweight. Methods: Central adjudication of mild cognitive impairment and probable dementia was...
Article
Objectives: To assess whether randomization to 10 years of lifestyle intervention to induce and maintain weight loss improves cognitive function. Design: Randomized controlled clinical trial. Setting: Data obtained as part of the Action for Health in Diabetes (Look AHEAD) trial (NCT00017953) and Look AHEAD Continuation study (U01 DK057136-15)....
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The purpose of this study is to explore gender differences in reasons for losing weight, weight loss methods, and weight loss behaviors prior to and during a weight loss maintenance trial. This is a secondary analysis of data from a 24-month randomized controlled trial comparing Self-Directed or Guided phone-based weight loss maintenance interventi...
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Objective: We compared 3-year achievement of an American Diabetes Association composite treatment goal (HbA1c <7.0%, LDL cholesterol <100 mg/dL, and systolic blood pressure <130 mmHg) after 2 years of intensive lifestyle-medical management intervention, with and without Roux-en-Y gastric bypass, with one additional year of usual care. Research de...
Article
Behavioral weight loss programs help people achieve clinically meaningful weight losses (8–10% of starting body weight). Despite data showing that only half of participants achieve this goal, a “one size fits all” approach is normative. This weight loss intervention science gap calls for adaptive interventions that provide the “right treatment at t...
Article
Genetic studies have identified a glutamate-ammonia ligase gene (GLUL) polymorphism associated with cardiovascular disease morbidity and mortality among people with type 2 diabetes (T2D). We sought to determine whether GLUL rs10911021 is associated prospectively with adjudicated cardiovascular composite end points among overweight/obese individuals...
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Self-weighing frequency is associated with lower body weight and less weight gain. This study describes self-weighing frequency in two samples of working adults from different fields: office-based and transit employees. Self-weighing frequency and demographic information were self-reported at baseline measurement of two worksite interventions. Data...
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Regulatory focus theory proposes 2 self-regulatory orientations: promotion focus - related to achieving aspirations and positive outcomes - and prevention focus - related to fulfilling responsibilities and preventing negative outcomes. The investigation examined whether regulatory focus and proximity to goal weight moderated the effectiveness of a...
Article
Background: Obesity is associated with higher risk of atrial fibrillation (AF), but the impact of behavioral weight loss interventions on atrial fibrillation (AF) risk in persons with diabetes is unknown. We addressed this question in the Look AHEAD randomized trial. Methods and Results: 5067 overweight or obese individuals 45–76 years old with typ...
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Examine the relationship between 1- and 2-month weight loss (WL) and 8-year WL among participants enrolled in a lifestyle intervention. 2,290 Look AHEAD participants (BMI: 35.65 ± 5.93 kg/m(2) ) with type 2 diabetes received an intensive behavioral WL intervention. 1- and 2-month WL were associated with yearly WL through Year 8 (P's < 0.0001). At M...
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Conventional treatments for patients with type 2 diabetes are often inadequate. We aimed to assess outcomes of diabetes control and treatment risks 2 years after adding Roux-en-Y gastric bypass to intensive lifestyle and medical management. We report 2-year outcomes of a 5-year randomised trial (the Diabetes Surgery Study) at four teaching hospital...
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Observational evidence from behavioral weight control trials and community studies suggests that greater frequency of weighing oneself, or tracking weight, is associated with better weight outcomes. Conversely, it has also been suggested that frequent weight tracking may have a negative impact on mental health and outcomes during weight loss, but t...
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Objective: To assess the relative impact of an intensive lifestyle intervention (ILI) on use and costs of health care within the Look AHEAD trial. Research design and methods: A total of 5,121 overweight or obese adults with type 2 diabetes were randomly assigned to an ILI that promoted weight loss or to a comparison condition of diabetes suppor...
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Weight losses in lifestyle interventions are variable, yet prediction of long-term success is difficult.Objective The utility of using various weight loss thresholds in the first 2 months of treatment for predicting 1-year outcomes was examined.Methods Participants included 2327 adults with type 2 diabetes (BMI:35.8 ± 6.0) randomized to the intensi...
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Objective Examine the effect of weekday exposure over six months to different lunch sizes on energy intake and body weight in a free-living sample of working adults. Design and Methods Adults (n=233) were randomly assigned to one of three lunch size groups (400 kcal; 800 kcal; 1600 kcal) or to a no-free lunch control group for six months. Weight a...
Article
Objective: Predicting outcome in weight loss trials from baseline characteristics has proved difficult. Readiness to change is typically measured by self-report. Methods: Performance of a behavioral task, completion of food records, from the screening period in the Look AHEAD study (n = 549 at four clinical centers) was assessed. Completeness of...
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Objective Weight loss programs are often conducted in a group format, but it is unclear whether weight losses or adherence cluster within treatment group and whether characteristics of the group (e.g., size or homogeneity) affect outcomes. We examined these questions within Look AHEAD, a multicenter study of the effects of an intensive lifestyle in...
Article
Objective To identify baseline attributes associated with consecutively missed data collection visits during the first 48 months of Look AHEAD—a randomized, controlled trial in 5,145 overweight/obese adults with type 2 diabetes designed to determine the long-term health benefits of weight loss achieved by lifestyle change. Design and Methods The an...
Article
Objective: To evaluate 8-year weight losses achieved with intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study. Design and methods: Look AHEAD assessed the effects of intentional weight loss on cardiovascular morbidity and mortality in 5,145 overweight/obese adults with type 2 diabetes, randomly assigned...
Article
The present research compared a self-report measure of usual eating behaviors with two laboratory-based behavioral measures of food reward and food preference. Eating behaviors were measured among 233 working adults. A self-report measure was the Three Factor Eating Questionnaire (TFEQ) Restraint, Disinhibition and Hunger subscales. Laboratory meas...
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Promotion and prevention focus have been shown to uniquely predict the initiation and maintenance of behavior change, but the behavioral tasks underlying these effects have not been specified. We examined the effects of regulatory focus on how smokers responded to initial slips and whether smokers were able to avoid slips after initial cessation. A...
Article
Environmental modifications have been shown to increase short-term stair use, longer-term success is unclear. This study assessed the 2-year effectiveness of an environmental intervention promoting worksite stair use. We assessed stair use at work by means of self-reports and infrared beam counters (which send a safe and invisible beam of infrared...
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Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primar...
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Background: Weight loss is recommended for overweight or obese patients with type 2 diabetes on the basis of short-term studies, but long-term effects on cardiovascular disease remain unknown. We examined whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among such patients. Methods:...
Article
Controlling glycemia, blood pressure, and cholesterol is important for patients with diabetes. How best to achieve this goal is unknown. To compare Roux-en-Y gastric bypass with lifestyle and intensive medical management to achieve control of comorbid risk factors. A 12-month, 2-group unblinded randomized trial at 4 teaching hospitals in the United...
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Background With increasing obesity rates worldwide, more and more people are actively attempting to lose weight or avoid weight gain, but relatively little is known about what specific behaviors comprise these efforts and which, if any, are associated with better weight control over time. Methods This paper reports relationships between body weigh...
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Objective: The Keep It Off trial evaluated the efficacy of a phone-based weight loss maintenance intervention among adults who had recently lost weight in Minnesota (2007-2010). Methods: 419 adults who had recently lost ≥ 10% of their body weight were randomized to the "Guided" or "Self-Directed" intervention. Guided participants received a 10 s...
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The Resilience for Eating and Activity Despite Inequality (READI) cohort was established to address the following two key aims: to investigate the pathways (personal, social and structural) by which socio-economic disadvantage influences lifestyle choices associated with obesity risk (physical inactivity, poor dietary choices) and to explore mechan...
Article
Objective: To investigate factors (ability, motivation and the environment) that act as barriers to limiting fast-food consumption in women who live in an environment that is supportive of poor eating habits. Design: Cross-sectional study using self-reports of individual-level data and objectively measured environmental data. Multilevel logistic...
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Objective: Little is known about the relationship between weight change and workplace absenteeism. The purpose of this study was to examine the degree to which weight change predicted 2-year absenteeism. Methods: A longitudinal analysis of 1,228 employees enrolled in a worksite-randomized controlled trial was performed. Participants were all wor...
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Background: Providing material incentives for weight loss is a class of intervention strategies that has received considerable attention; however, the effectiveness of this class of strategies is uncertain. Attending to distinctions among incentive strategies may clarify our understanding of prior work and inform the design of future interventions...
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This article has been withdrawn at the request of the authors. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
Article
Lifestyle-based interventions, which typically promote various behavior modification strategies, can serve as a setting for evaluating specific behaviors and strategies thought to promote or hinder weight loss. The aim of our study was to test the associations of self-monitoring (ie, self-weighing and food journal completion) and eating-related (ie...
Article
The purpose of this review is to spark integrative thinking in the area of eating behaviors by critically examining research on exemplary constructs in this area. The eating behaviors food responsiveness, enjoyment of eating, satiety responsiveness, eating in the absence of hunger, reinforcing value of food, eating disinhibition and impulsivity/sel...
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Background: Obesity and depression are closely linked, and each has been associated with disability. However, few studies have assessed inter-relationships between these conditions. Design and methods: In this study, 4641 women aged 40-65 completed a structured telephone interview including self-reported height and weight, the Patient Health Que...
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Background Research suggests that the interaction between biological susceptibility and environmental risk is complex and that further study of behavioral typologies related to obesity and associated behaviors is important to further elucidate the nature of obesity risk and how to approach it for intervention. The current investigation aims to iden...
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U.S. adults are at unprecedented risk of becoming overweight or obese, and most scientists believe the primary cause is an obesogenic environment. Worksites provide an opportunity to shape the environments of adults to reduce obesity risk. The goal of this group-randomized trial was to implement a four-component environmental intervention at the wo...
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This paper reviews research studies evaluating the use of financial incentives to promote weight control conducted between 1972 and 2010. It provides an overview of behavioral theories pertaining to incentives and describes empirical studies evaluating specific aspects of incentives. Research on financial incentives and weight control has a history...
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Nutrition Facts labels can keep consumers better informed about their diets' nutritional composition, however, consumers currently do not understand these labels well or use them often. Thus, modifying existing labels may benefit public health. The present study tracked the visual attention of individuals making simulated food-purchasing decisions...
Article
This cross-sectional study aimed to identify sociodemographic and behavioural characteristics of 'overweight-resilient' women, that is, women who were in a healthy body weight range, despite living in socioeconomically disadvantaged neighbourhoods that place them at increased risk of obesity. The study also aimed to test a comprehensive theoretical...
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Some evidence suggests that physical activity programs mainly attract employees who are already active. This study examined the degree to which baseline physical activity was associated with enrollment in worksite walking clubs. All variables were measured at baseline. Walking club participation was measured over 2 years. There were 642 individuals...
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Nutrition label use could help consumers eat healthfully. Despite consumers reporting label use, diets are not very healthful and obesity rates continue to rise. The present study investigated whether self-reported label use matches objectively measured label viewing by monitoring the gaze of individuals viewing labels. The present study monitored...
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Little is known about the association between self-weighing frequency and weight gain prevention, particularly in worksite populations. The degree to which self-weighing frequency predicted 2-year body weight change in working adults was examined. The association between self-weighing frequency (monthly or less, weekly, daily, or more) and 24-month...
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Low concentrations of circulating vitamin D are common with obesity and may represent a potential mechanism explaining the elevated risk of certain cancers and cardiovascular outcomes observed in individuals who are overweight or obese. The objective of this study was to investigate the effects of 12 mo of weight loss through caloric restriction, e...
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Both obesity and depression have been associated with significant increases in health care costs. Previous research has not examined whether cost increases associated with obesity could be explained by confounding effects of depression. Examine whether the association between obesity and health care costs is explained by co-occurring depression. Cr...
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Objective: To characterize perceived barriers to healthful eating in a sample of obese, treatment-seeking adults and to examine whether changes in barriers are associated with energy intake and body weight. Design: Observational study based on findings from a randomized, controlled behavioral weight-loss trial. Participants: Participants were...
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Objective: To investigate whether sex differences exist in the pattern of change in C-reactive protein (CRP) levels during weight loss, and whether the associations between weight change and CRP change differ by the types of anthropometric variables. Design: Longitudinal, prospective analysis of subjects participating in an intentional weight lo...
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Clinical obesity treatments are of limited reach. Self-directed weight control attempts are common, but little attention has been given to providing guidance for such efforts in the population. The present research tests a brief intervention approach to weight control. Pilot data were collected from 66 University of Minnesota employees (72.7% women...
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Social norms are theoretically hypothesized to influence health-related behaviors such as physical activity and eating behaviors. However, empirical evidence relating social norms to these behaviors, independently of other more commonly-investigated social constructs such as social support, is scarce and findings equivocal, perhaps due to limitatio...
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To assess differences in weight regain one year after an 18-month obesity treatment with standard behavior therapy (SBT) or maintenance-tailored therapy for obesity (MTT). 213 obese adult volunteers were treated for 18 months using SBT with fixed behavioral prescriptions or MTT that employed varied behavioral prescriptions with treatment breaks. Fo...
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To examine the association between improvement in depression and loss of weight among women with depressive symptoms entering a behavioral weight loss program. Women aged 40 to 65 with body mass index (BMI) of 30 or more and co-occurring symptoms of depression were identified by a population-based survey. A total of 203 of these women were enrolled...
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Data from a trial of a 26-session structured group behavioral weight loss intervention were used to examine how group attendance, weight loss, and changes in depression clustered within therapy groups. Participants were recruited via a population-based survey of female health plan members aged 40 to 65. The sample included 143 women attending 13 th...
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Background: Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus, but no long-term data are available. We examined the effects of lifestyle intervention on changes in weight, fitness, and CVD risk factors during a 4-year study. Methods: The...
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This chapter presents a systematic review of available data on environmental factors that may have contributed to recent trends in population body weight. It focuses especially on the US population, for which data on environmental change and body weight are most complete. The cause of the obesity epidemic that has affected the world for the last th...
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This chapter presents a conceptualization of the causes of population obesity, discusses the implications of this conceptualization for public health interventions, and reviews empirical work that has attempted to address obesity treatment and prevention in entire populations. Youth interventions have been delivered primarily through schools. Adult...
Chapter
The case for a preventative approach to the obesity epidemic is compelling. Obesity poses what is arguably one of the most significant threats to population health that is currently faced. The data presented in this book highlight just how common obesity has become in children and in adults across the globe, and how it impacts disproportionately on...
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Obesity is associated with clinical depression among women. However, depressed women are often excluded from weight loss trials. This study examined treatment outcomes among women with comorbid obesity and depression. Two hundred three (203) women were randomized to behavioral weight loss (n = 102) or behavioral weight loss combined with cognitive-...