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Peer Support Groups for Weight Loss


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Purpose of Review Social support, especially from peers, has been found to contribute to successful weight loss and long-term weight loss maintenance. Peer support groups may represent a particularly effective intervention technique for weight loss. This review focuses upon peer support weight loss interventions with the objective of identifying common elements of successful programs. Recent Findings Peer support interventions often consist of expert-led educational content, supplemented by peer-led activities or discussion. Peer groups may provide support to individuals who have little social support in their normal lives. Interventions are often designed for pre-existing groups, especially high-risk groups such as women from ethnic minorities. Men are underrepresented in weight loss programs and often perceive “dieting” as feminine. However, several peer programs for male sports fans have successfully resulted in weight loss and fostering support for healthy lifestyle among male peers. In addition to professionally created peer support groups, many online weight loss communities are created and moderated by peers. Online communities allow participants to share peer support similar to in-person formats. Summary Many peer support interventions show significant short-term weight loss. Group members frequently report that peer support was critical to their weight loss success. A sense of community among likeminded individuals with similar goals was frequently cited. Online peer support groups are becoming increasingly prevalent, may fulfill similar needs to in-person groups, and have additional advantages in accessibility, and access to a larger peer network, and may facilitate long-term adherence.
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Peer Support Groups for Weight Loss
Kelsey Ufholz
#The Author(s) 2020
Purpose of Review Social support, especially from peers, has been found to contribute to successful weight loss and long-term weight
loss maintenance. Peer support groups may represent a particularly effective intervention technique for weight loss. This review focuses
upon peer support weight loss interventions with the objective of identifying common elements of successful programs.
Recent Findings Peer support interventions often consist of expert-led educational content, supplemented by peer-led activities or
discussion. Peer groups may provide support to individuals who have little social support in their normal lives. Interventions are
often designed for pre-existing groups, especially high-risk groups such as women from ethnic minorities. Men are underrepre-
sented in weight loss programs and often perceive dietingas feminine. However, several peer programs for male sports fans
have successfully resulted in weight loss and fostering support for healthy lifestyle among male peers. In addition to profession-
ally created peer support groups, many online weight loss communities are created and moderated by peers. Online communities
allow participants to share peer support similar to in-person formats.
Summary Many peer support interventions show significant short-term weight loss. Group members frequently report that peer
support was critical to their weight loss success. A sense of community among likeminded individuals with similar goals was
frequently cited. Online peer support groups are becoming increasingly prevalent, may fulfill similar needs to in-person groups,
and have additional advantages in accessibility, and access to a larger peer network, and may facilitate long-term adherence.
Keywords Peer support .Weight loss .Weight loss maintenance .Online support
Introduction: Challenges of Commercial
Weight Loss Programs
Obesity is a serious growing health concern. In 20172018,
42.4% of American adults were obese [1]. Because of the
well-known ill health associated with obesity [2] including
greater risk of cardiovascular disease [3], many obese individ-
uals enroll in weight loss programs to improve their health.
Unfortunately, very few individuals successfully lose weight:
Men with a BMI > 45 have a 1 in 5 chance of losing 5% body
weight, while women (1 in 6 to10 chance) or men with a BMI
3044.9 face even greater odds (1 in 8 to 12 chance) [4]. Even
for those who defy the odds, long-term weight loss mainte-
nance is difficult. A meta-analysis of studies examining
weight loss among American adults enrolled in structured
weight loss programs with at least 2 years of follow-up data
found that 5 years post weight loss, only 23.4% of initial
weight loss was maintained [5].
found only slightly greater weight loss compared with control
or education-only comparison groups. Results ranged from
0.1 greater weight loss at 12 months for Atkins to 4.0% greater
weight loss at 36 months, with attenuated effects thereafter,
for very low calorie programs such as Medifast [6]. One ex-
planation for both lack of initial weight loss and maintenance
is unsustainability. Most trials reviewed lasted about 12 weeks
and showed high attrition [6]. A meta-analysis of similar com-
mercial weight loss programs, such as Weight Watchers and
Biggest Losers Club, found that the majority of participants
who began these programs (57%) lost less than 5% of their
body weight. Almost half of all studies (49%) reported attri-
tion rates > 30% [7]. Conversely, longer term involvement
was associated with greater success. For example, among
Jenny Craig platinum program members, participants who
remained in the program for 4052 weeks lost 12.0% (SD
7.2%) body weight, while those who left after 14 weeks lost
This article is part of the Topical Collection on Obesity and Diet
*Kelsey Ufholz
Department of Family Medicine and Community Health, Case
Western Reserve University, 11100 Euclid Avenue, Suite 1056,
Cleveland, OH 44106, USA
Published online: 22 August 2020
Current Cardiovascular Risk Reports (2020) 14: 19
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.1% (SD 1.6%) body weight. Unfortunately, only 6.6% of
original enrollees were still in the program by week 52, with a
full 27% dropping out within the first month [8]. Overall,
long-term weight loss is especially difficult often because
those seeking to lose weight discontinue their efforts.
We know that social support can enhance the effectiveness
of structured weight loss programs. Despite obstacles, some
formerly overweight individuals do manage to successfully
lose weight and maintain weight loss. An often-cited review
by Elfhag and Rossner found that these individuals had sev-
eral strategies in common, including increased support from
their social network [9]. The beneficial role of social support
during weight loss and maintenance is well verified.
Participants who were recruited to a weight loss program with
a friend or family member lost more weight at 4 months,
maintained the weight loss at 10 months, and showed lower
rates of attrition compared with participants recruited to a
standard weight loss program without any accompanying so-
cial support [10]. A recent meta-analysis of factors associated
with greater adherence to a weight loss program identified the
positive impact of social support (RR 1.29; 95% CI 1.24
1.34) [11]. Yet, while the support of loved ones can be crucial
and individuals maintaining recent weight loss cite support
from family as especially important and wanted, they also
cited these same people as obstacles, for example, tempting
them with foods which do not fit within their diet [12], possi-
bly because they are not experiencing the same process. This
explains why during focus groups about what they
found most helpful in their weight loss journey, women
maintaining recent weight loss listed a sense of shared
community among their peers [12].
Many health behavior change theories incorporate social
support as an active change element. Social cognitive theory
[13,14] is a behavior change theory often employed in the
context of socially supported weight loss (see Table 1).
Interventions guided by this model teach behavioral modifi-
cation techniques such as goal setting and self-monitoring.
The peer support format allows members to provide positive
reinforcement for success, helping them to build self-efficacy.
Peer coaches and successful members may model successful
behavior change, allowing for observational learning by less
advanced members. Self-determination theory is an alternate
theory that may be incorporated into successful peer support
weight loss programs [15]. For example, skill-building and
educational components can increase participantssense of
competence, or ability to complete tasks and achieve goals,
while the support provided by peers will build a sense of
relatedness or sense of being valued and cared for by others.
Some interventions utilize theories, such as cognitive behav-
ioral theory, that are traditionally associated with individual-
level psychotherapy rather than groups [16] with the addition
of peer support components [17]. Such interventions often
have peer support as an adjunct rather than as the primary
active component. Other interventions are based not upon
theoretical models but upon prior successful interventions
for other conditions such as diabetes [18].
How Peer Support Groups Function
Peer support is defined as the provision of emotional, ap-
praisal, and informational assistance by a created social net-
work member who processes experiential knowledge of a
specific behavior or stressor and similar characteristics as the
target population[19]. A peer support group is a group of
similar individuals who, because of shared experience, are
able to provide emotional and practical support.
Peer support groups facilitate weight loss among their mem-
bers through several mechanisms. Overweight individuals may
have weak structural support, which refers to the extent to which
a person is embedded into their social groups, including family,
friends, and peer groups [12]. Overweight has been associated
with the absence of close friends [20] both among adults and
adolescents [21]. This may be partly due to bias. While over-
weight youth select possible friends without regard to BMI,
healthy weight youth were 30% more likely to choose a non-
overweight friend rather than an overweight friend [22]. For
individuals with limited social networks, peer support groups
may be necessary to provide otherwise lacking structural support.
Peer support groups also provide members with functional
support, which refers to specific actions that peers may per-
form for each other, such as providing emotional support or
helpful information. Focus groups have found that such forms
of support are highly desired, with shared community and
increased self-efficacy, both forms of functional support, per-
ceived as most helpful to weight loss maintenance [12]. Peer
support groups need not meet in person to provide functional
support. The Social Support Behavior Code lists five types of
social support: informational support, such as providing facts,
advice, and alternative perspectives upon situations; esteem
support, such as compliments and validating othersexperi-
ences; network support, such as offering to spend time with
others or providing access to resources; tangible support, such
as offering the loan of something needed or to jointly com-
plete a task; and emotional support, such as displays of empa-
thy, sympathy, and encouragement [23,24••]. An analysis of
comments made in an online support forum for bariatric sur-
gery patients noted that, although support which could be
offered solely through anonymous written/verbal means, such
as dietary advice (informational support) and encouragement
(emotional support) were most frequently offered, network
and tangible support were still present [24••]. Peer groups also
create social norms, defined as a social groups expectation of
appropriate behavior in a given circumstances [25,26]. Social
norms have long been known to influence eating behavior
[27], both in healthy and unhealthy ways. A systematicreview
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Table 1 Summary of characteristics of peer support group interventions
Author Date Duration Setting Target Intervention
Study type Theory or model
Active components Outcomes
Petrel, R. J. 2016 12 weeks Hockey club
Men Hockey Fans in
(Hockey FIT)
RCT with
weight list
Football Fans in
Training (FFIT)
Educational sessions with coaches teaching
behavior change techniques:
Goal setting
Healthy eating advice
Physical activity training
*Weight lost
*BMI change
Hunt et al. 2014 12 weeks
active +
nance phase
Men Football Fans in
RCT with
weight list
None given
Novel gender
Educational sessions with coaches teaching
behavior change techniques:
Goal setting
Healthy eating advice
Physical activity training
*Weight lost
*BMI change
*Body fat
*Blood pressure
*Self-report PA
sedentary time
*Self-report diet
quality of life
Dutton et al. 2015 6 months Family
with diabetes or
None given Single group
Program and
Educational office in primary care office
provides information on energy restriction,
increasing PA, Self-monitoring
Stimulus control, relapse prevention
Phone call with peer coaches
#Weight loss
et al.
2008 10 weeks
active +
22 weeks
and 1-year
church in
African-Americans Project HEAL:
Eating, Active
Single group
Chronic Disease
ent Program
Peer coach-led weekly action plans,
self-management, group feedback,
#Weight lost
#Fat consumption
#Saturated fat
Physical activity
#Sedentary time,
quality of life
Weight loss locus
of control
Kulik et al. 2015 16 weeks NA Adolescent females None given RCT compare
Weight loss
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Table 1 (continued)
Author Date Duration Setting Target Intervention
Study type Theory or model
Active components Outcomes
enhanced peer
Nutrition and PA education; behavioral skills;
small group activities; peer Facebook chats;
check-in with peers
Simpson, S. 2018 12 months Glasgow,
NA HelpMeDoIt Feasibility RCT
with a
control group
Social support
social cognitive
theory; control
Website to provide content on healthy eating
goals; users invited to recruit helpersfrom
within their social circle
Physical activity
A. L.
2015 8 weeks Emerging
Latina immigrants ESENCIAL
Para Vivir
(Essential for
Single group
pilot study
theory; Diabetes
Promotoras provide health education *Weight loss
*Physical activity
K. A. et al.
2016 24 weeks Community
Adults with serious
mental illness
None given Single group
pilot study
Lifestyle coach delivered content; hands-on
small group activities; twice weekly
optional exercise sessions; Facebook chats;
Fitbit accelerometers
#Weight loss
Lee et al. 2018 16 weeks Local
ing Against
Single group
pilot study
Social cognitive
In-person educational lectures; peer group
discussion; daily feedback/support text
#Weight loss
#Self-efficacy of
Stages of change
Self-efficacy of
Perceived social
Perceived stress
Systolic blood
Diastolic blood
pressure, waist
et al.
2017 6 months +
30 months
Online Women in rural
RCT with an
online content
only control
Online delivered nutrition and physical
activity education; food diary; physical
activity tracker; supplemented with emails
from a dietician or access to a peer
discussion board
Weight loss
*Indicates greater changes compared with control
#indicates statistically significant pre-post changes
19 Page 4 of 11 Curr Cardiovasc Risk Rep (2020) 14: 19
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and meta-analysis found that both high-intake norms (standard-
ized mean difference = 0.41; 95% CI 0.20 to 0.63; p< 0.0001)
and low-intake norms (standardized mean difference = 0.35;
95% CI 0.59 to 0.10; p= 0.005) moderately influenced
amount of food eaten [28]. Peer support groups, especially those
with access to weight loss professionals, may be important to
create healthy alternate norms among members.
The focus in this review is on the impact of peer support
interventions. Usually, the primary outcome is weight lost, in
absolute terms or as a body weight percentage. Successful peer
support groups targeted at weight loss may also impact comor-
bidities commonly associated with obesity, with varying degrees
of success. A recent meta-analysis of 26 randomized controlled
trials found that compared with control, peer support interven-
tions for weight loss led to improved glycemic control,
(HbA1c = 0.22%; 95% CI 0.40 to 0.04; p=0.02) and de-
creased obesity (BMI = 0.83 kg/m
; 95% CI 1.58 to 0.07;
p= 0.03), but had no significant effect upon systolic blood pres-
sure (0.90 mmHG; 95% CI 3.05 to 1.24 mmHG). The au-
thors speculate that high levels of attrition and selection bias may
have influenced results [29]. Commercial weight loss programs
not intended to improve diabetes or other cardiovascular risks
may nevertheless have a desirable effect on these conditions. A
randomized controlled trial found that participants enrolled in
Weight Watchers showed greater improvements in both weight
loss (difference = 3.3% body weight at 18 months; p<0.008)
(difference = 1.7% body weight at 24 months; p< 0.032) and
HbA1c (difference = 1.0 at 18 and 24 months; p<0.04)com-
pared with those assigned to a self-directed program created by
the National Diabetes Education Program. Furthermore, both
groups showed similar improvements in cardiovascular risk fac-
tors, including HDL cholesterol, diastolic, and systolic blood
pressure [30]. Whether interventions for obesity-related comor-
bidities will also impact BMI remains uncertain. A separate
meta-analysis found that peer support interventions for diabetes
management improved systolic blood pressure (2.07 mmHG;
95% CI 0.35 to 3.79 mmHG; p= 0.02), but not diastolic blood
pressure, cholesterol, BMI, diet, or physical activity. Because the
selected studies focused upon diabetic control, cardiovascular
risk factors, including BMI, were secondary outcomes and par-
ticipants in most studies had only normal or mildly elevated
values [31]. Overall peer support groups aimed at weight man-
agement can, but will not necessarily, also improve symptoms of
obesity-related comorbidities.
Common Traits of Peer Support Groups
A search using the terms peer support,”“peer support
group,”“weight loss,and related terms in various combina-
tions was carried out in PubMed, Google Scholar, etc., to
identify papers published in 2015 and later. Approximately
70 relevant papers were ultimately reviewed. Peer support
groups for weight loss showed several similarities. Much like
other weight loss programs, results tended to be mixed, with
members showing short-term results followed by later weight
regain [32]. Occasionally, comparisons of peer support inter-
ventions with control groups that did not explicitly feature
peer support, showed no difference between groups [33].
Sometimes, this may have been because participants did not
utilize the peer support features, especially if these features
were an adjunct to a traditional weight loss program [32].
Many peer support groups did not require attendance, but
allowed participants to attend or not attend according to their
interest or availability, although greater attendance was often
associated with improved outcomes. For example, a peer sup-
port group for patients following bariatric surgery showed that
the number of sessions attended in the first year was related to
weight lost in the first year. Similar results were found for
number of sessions attended 25 years post-surgery [34].
Many groups deliberately cultivated a sense of community
among their members by selectively recruiting from high-risk
groups. Often, these groups were a minority group or popula-
tion who are traditionally difficult to reach with mainstream
weight loss programs. For example, the STAR project was a
feasibility pre-post study of a peer support group for African-
American women [35], an ethnic group with higher rates of
obesity than many other ethnic groups [36]. Following
16 weeks of biweekly in-person peer group session and daily
text messages, the women noted modest (3.7 lbs.; SD =
3.5 lbs.) but statistically significant (p< 0.01) weight loss
and decreased BMI (0.6 kg/m
; SD = 0.6 kg/m
0.001) [35]. Similarly, Project HEAL, a pilot study of a
church-based peer support group for African-Americans liv-
ing in Harlem, New York, showed that participants lost
4.4 lbs. at 10 weeks (p< 0.01), 8.4 lbs. at 22 weeks (p=
0.003), and 9.8 lbs. after 1 year (p= 0.001) and reported de-
creased fat consumption (7.6 daily fat intake in grams at
10 weeks; p=0.46) (4.0 daily fat intake in grams at
22 weeks; p= 0.27) and sedentary time (1.3 h/day at
10 week; p= 0.34) (2.9 h/day at 1 year; p< 0.01). Daily
servings of fruit and vegetables also showed a modest (0.7
servings/day) but statistically significant increase at 22 weeks
(p= 0.041) and 1 year (p=0.039)[37]. Another pilot weight
loss intervention enrolled African-Americans who presented
with obesity and at least one cardiovascular risk, such as ele-
vated blood pressure or A1C. Participants were recruited
through a primary care practice and received biweekly visits
with healthcare professionals, along with phone calls from
peer coaches. After 6 months, participants lost an average of
4.5 kg and 27% lost > 5% of their body weight [18]. What
these three interventions have in common is that they were
tailored to the unique cultural needs of the African-American
population. Two out of three were based in or recruited
through churches and all actively recruited local community
leaders who worked alongside healthcare educators.
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In addition to ethnic minorities, other high-risk groups,
such as patients with serious mental illness, may benefit from
peer support groups. Individuals with serious mental illness,
such as schizophrenia or bipolar disorder, have rates of
overweight/obesity exceeding 80% [38], and this group often
struggles with finding adequate social support [39]. PeerFIT
was a 24-week peer group intervention for individual with
serious mental illness. The program consisted of weekly in-
person sessions lead by lifestyle coaches, optional twice
weekly group exercise sessions lead by fitness instructors
from the local YMCA, physical activity tracking with FitBit
accelerometers, program-related text messages, and peer-to-
peer support on social media. Post-intervention results showed
that participants lost an average of 7.76 lbs. (SD = 12.4 lbs.; p=
0.005) and decreased their BMI significantly (1.25 kg/m
SD = 1.99 kg/m
;p= 0.005), with 28% achieving clinically
significantweightlossof> 5% body weight [40]. Consistent
with other peer support groups, members perceived a sense of
community, with shared goals among individuals facing the
same challenges, who could give and receive advice unique
to their common goals, as essential to their success [41].
Perceived social support was found to be positively associated
with weight loss (r= 0.59; p= 0.002) [40], further highlighting
its importance.
Often community-based interventions make use of peer
coaches, defined as individuals who participate in some capac-
ity in health promotion but have no formal professional health
care training and have an existing relationship or other connec-
tion with the community or population receiving care[18]. One
example is ESENCIAL Para Vivir (Essential for Life), a peer
support intervention designed for Latina immigrants, another
ethnic group with disproportionately high rates of obesity [36].
This peer support intervention was delivered by peer coaches
known as promotoras.Compared with data from a historical
control group, after 8 weeks, participants showed significant
weight loss (2.1 kg; SD = 2.6 kg; p< 0.001) although this at-
tenuated at 6 months (p= 0.67). Participants also showed im-
proved dietary habits as measured by the Dietary Behavioral
Strategies Scale (p< 0.001) and increased self-reported physical
activity, as measured by the Global Physical Activity
Questionnaire (47.1-min increase at 8 weeks; p= 0.004) (54.3-
min increase at 6 months; p=0.026) [17]. During post-
intervention focus groups, participants stated a desire for cultur-
ally sensitive programs which incorporated traditional foods and
customs, practical tips for physical activity, and involved family
members, especially husbands [17].
Peer Group Weight Loss Interventions
for Men
Obesity rates among adult men (34.3%; 95% CI 32.636.1)
and women (38.3%; 95% CI 36.140.5) are both worryingly
high [36]. Yet, many weight loss interventions are designed
solely for women. Even in interventions not designed exclu-
sively for women, the majority of participants tend to be wom-
en. Only 5% of weight loss trials utilize all-male samples,
while 32% utilize an all-female sample; 27% of all weight loss
intervention participants are men, and only 1.8% are men of
an ethnic minority [42]. While men may need weight loss
interventions, such interventions do not appeal to them.
Semi-structured interviews of mens experience in weight
loss interventions found that men perceived behaviors such as
dieting and self-monitoring weight as feminine. Men who
attended commercial weight loss programs reported feeling
uncomfortable, ostracized, and that the program was better
suited to women [43]. A series of focus groups among men
in southwest England gathered their perspectives on diet,
physical activity, and weight loss behaviors. It was found that
these men regarded dieting, counting calories, and commer-
cial weight loss groups as a womensthing,of no interest to
proper blokes.Physical activity was more socially accept-
able, especially in a sporting context. Few men reported re-
ceiving peer support for weight loss from friends. In contrast,
family, especially wives and girlfriends, were seen as support-
ive and knowledgeable about nutrition [44]. Collectively,
these results highlight a need for weight loss interventions
focused on mens concerns, especially ones which cultivate
peer support for dieting, physical activity, weight monitoring,
etc. from other men.
Several recent weight loss programs have been designed
exclusively for men, taking advantage of already existing
male-oriented groups. One example is Football Fans in
Training (FFIT), an intervention for members of a Scottish
professional football club (soccer fan group). FFIT combined
educational content, such as how to self-monitor and set spe-
cific goals, with supervised physical activity. Early interven-
tion sessions emphasized the educational components, while
later sessions focused more upon physical activity. The pro-
gram was designed to tap into a pre-existing community and
work with rather than against prevailing understandings of
masculinity.The intervention was overseen by community
football coaches who had been trained by the research staff
and took place at the clubshomestadium[45]. Compared
with a wait-list control group who only received a weight
management book, the intervention group showed significant
changes in BMI (1.66 kg/m
;95%CI1.93 to 1.40 kg/m
at 12 weeks; p< 0.0001) (1.56 kg/m
; 95% CI 1.82 to
1.29 kg/m
at 12 months; p< 0.0001), waist circumference
(5.57 cm; 95% CI 6.41 to 4.72 cm at 12 weeks
p< 0.0001) (5.12 cm; 95% CI 5.97 to 4.27 cm at
12 months; p< 0.0001), body fat percentage (2.16%; 95%
CI 2.81 to 1.51 at 12 weeks; p<0.0001) (2.15%; 95%
CI 2.78 to 1.52%at12months;p< 0.0001), as well
as improvements in self-reported physical activity in MET-
minutes/week (median = 2.38; IQR 1.90 to 2.98 at 12 weeks;
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p< 0.0001) (median = 1.49, IQR 1.11 to 1.98 at 12 months;
p= 0.008), healthy diet as measured by Dietary Instrument
for Nutrition Education scores for fatty foods (4.39; 95%
CI 5.16 to 3.61; p< 0.0001 at 12 weeks) (2.74; 95%
CI 3.52 to 1.96; p< 0.0001 at 12 months), fruit and vegeta-
ble consumption (1.32; 95% CI 1.07 to 1.57; p<0.0001 at
12 weeks) (0.54; 95% CI 0.29 to 0.79; p< 0.0001 at 12 months),
sugary foods (1.52; 95% CI 1.83 to 1.21; p<0.0001 at
12 weeks) (0.87; 95% CI 1.18 to 0.56; p< 0.0001 at
12 months), and alcohol consumption (4.47 units/week;
95% CI 6.09 to 2.86; p< 0.001 at 12 weeks) (2.59 units/
week; 95% CI 4.21 to 0.97; p< 0.0017 at 12 months) [46].
During focus groups, participants expressed appreciation for a
community of men with similar interests and facing similar
challenges. Such a context allowed them to discuss weight-
related challenges without worrying about challenges to their
masculinity [47]. Weight loss programs such as this can and
have been adapted to other sporting contexts. Hockey FIT, de-
veloped for Canadian hockey fans, followed the same format as
FFIT and showed similar results. Compared with a wait-list
control, after 12 weeks, those who received Hockey FIT
showed reductions in waist circumference (2.8 cm; 95%
CI 5.0 to 0.6 cm; p=0.01) and BMI (0.9 kg/m
CI 1.4 to 0.4 kg/m
;p< 0.001) [45,48]. Post-intervention,
100% of participants reported healthier diet and 78% reported
increased physical activity. Critically, many of them cited re-
ceiving support from their coaches and fellow participants as
critical for their success and found it helpful that they were part
of a community of like-minded people, reinforcing a consistent
theme among peer support groups for weight loss [48].
Online Peer Support
While many peer support groups consist of small groups
meeting in person, other formats have advantages (see
Table 2). Online weight loss communities have become pop-
ular over the past 10 years. These websites often include
features such as chat rooms, blogs, and discussion forums.
In-person peer support groups often encounter practical bar-
riers, such as geographic distance and difficulty finding trans-
portation to in-person events. Online formats, unlike in-person
support groups, are also untethered to specific times or dates.
In-person peer groups have a tacit expectation of reciprocal
support, in contrast to online peer groups in which pleas for
assistance may be borne by the group as a whole [49]. Internet
peer support group members endorsed preference for the
Internet community because they liked the anonymity, which
allowed greater freedom to discuss more sensitive topics, and
found the interactions to be non-judgmental, especially com-
pared with people in their lives such as friends and family
members [50].
Individuals who chose online peer support groups may
have different needs compared with those who utilize in-
person support groups. A survey of users of online health-
related social groups found that these individuals were dissat-
isfied with the support they received from their in-person net-
work [49]. Members of online peer support communities may
log into those communities whenever they feel in need of
extra validation or support. Such a format allows members
to customize their level of engagement.
Despite the different format, the active change elements of
online peer support groups may be quite similar to those pres-
ent in in-person peer groups. Surveys of members of
SparkPeople, an Internet weight loss community, stated that
in the past 4 weeks, they had at least once a day read weight-
related messages on discussion forums (56.8%), replied to
messages on forums (36.1%), and started weight-related dis-
cussions (18.5%) [50]. Even more so, members of these com-
munities said they received encouragement, motivation, rec-
ognition for success, accountability to a shared community,
humor, and information [50]. In other words, support offered
by the online community mirrored support offered by in-
person peer groups. Similarly, an examination of messages
posted on a forum of a large online bariatric surgery discus-
sion website found that the majority of messages aimed at
Table 2 A comparison of in-person and online peer support groups
Pros Cons
In-person Sense of community may be enhanced by person-to-person communication
Members may complete physical activity together, with a professional trainer
Skill-building activities, such as cooking classes, can be conducted in person
Group facilitators can monitor suggestions offered for accuracy
May have greater retention
Outspoken members may dominate
Group is limited to specific time and
May be difficult for socially anxious
Online Ability to recruit special populations that cannot assemble enough individuals for an in-person
group (bariatric patients, individuals with mental illness)
Members can access support without time or geographic restrictions
Access to larger peer support group
Cost-effective compared with in-person
May have greater long-term sustainability
Members can log in whenever it is convenient or they need extra support
Difficult to provide non-verbal,
tangible support
Unmonitored sites can promote
unhealthy social norms
Page 7 of 11 19Curr Cardiovasc Risk Rep (2020) 14: 19
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
both those who were preparing for surgery and those who
were adjusting to post-surgical life included emotional sup-
port, such as expressions of encouragement and sympathy
following setbacks, and instrumental support, such as recom-
mendations on specific foods and reappraising frustrating sit-
uations with family in a more positive manner [24••].
Some individuals choose online weight loss options as part
of a self-directed weight loss journey rather than seeking pro-
fessional help. However, just as professionally led in-person
weight loss interventions often involve peer support as part of
their method, online peer support groups are now being inte-
grated into both in-person and online weight loss interven-
tions. An example of an online-only weight loss program
which includes peer support is Noom. Program features in-
clude logging into an mHealth application (app)where
members may share food logs, weight loss goals, and chal-
lenges. Results found that receiving peer support did not di-
rectly predict weight loss (p= 0.08), but peer support did pre-
dict increases in food logging among participation (path coef-
ficient = 0.45, p< 0.05), which then predicted weight loss
(path coefficient = 0.37, p<0.05)[51].
Social media is a popular venue for member-created peer
support groups. Such venues have several unique features. As
of February 2019, 73% of American adults have used
YouTube and 69% have used Facebook, with many reporting
that they access social media platforms daily [52], suggesting
access to a very large peer support group. The level of ano-
nymity and detail varies based on media platform.
Comparisons of two branches of an online weight loss pro-
gram, one with an online discussion board and one with access
to a Facebook community, found that individuals who utilized
Facebook reported greater emotional support compared with
those who used the online discussion forum (1.0 point differ-
ence, p< 0.05). The authors speculated that these effects may
derive from differences in the nature of these media, in which
Facebook social support may be traced to specific individuals
via their detailed profiles, in contrast to anonymous discussion
posts. Noteworthy, active (56% body weight) and non-active
(6.1% body weight) users of the online program showed sim-
ilar weight loss results at 6 weeks (p> 0.108). Active users
were more satisfied with the program (0.30.7 point differ-
ence), reported greater compliance (0.31.0 point difference),
more perceived success (0.10.8 point difference), and greater
emotional (1.02.3 point difference), informational (1.12.4
point difference), and instrumental support (0.11.2 point dif-
ference) (p< 0.05, all differences), which may translate into
more sustained usage and greater success long term [53].
There may be limits to what can be achieved via online support.
A web-based weight loss program for rural women supplemented
with an online peer-led discussion blog was found to result in
modest weight loss (4.05.8 kg at 6 months). However, the weight
lost was no greater compared with the program without the peer
support blog (0.9 kg; 95% CI 0.8 to 2.7 kg at 6 months; p= 0.36)
or compared with a program supplemented by emails from a
professional counselor (1.7 kg; 95% CI 3.4 to 0.0 kg at
6 months; p= 0.56). Only about half (45%) the women with ac-
cess to the peer-led discussion blog used it in the first 6 months of
the study, and this percentage dropped further (22%) over the
course of the study. The authors speculated that participants may
have never felt like they were part of a community, essentially
making their intervention the same as the control group [32]and
once again highlighting the importance of shared community for
the success of peer support groups.
Practical Recommendations on Fostering
Shared Community
A consistent theme among peer support groups is the need for
a sense of shared community among members. This may be
achieved through several overlapping methods. To foster a
sense of relatedness, so that members feel heard and valued,
all members should be given a chance to share and express
opinions at each meeting. Members may be encouraged to
offer varied types of functional support, including emotional
support, informational support, and when possible tangible
support. Community may already exist if group members
are recruited from already existing groups, such as members
of the same church or employees at the same office.
Facilitators who share similar characteristics as group mem-
bers or advanced group members who transition into facilita-
tor roles may be perceived as more relatable and credible.
Some peer support groups incorporate hand-on educational
activities such as cooking classes. Such activities may, in addi-
tion to practical skills, give participants a sense of working to-
wards a common goal such as a shared meal. Group exercise
classes have the added benefits of friendly competition, fun, and
a break from monotony. Peers may actively support one another
such as holding a peers feet during sit-ups and cheering encour-
agement while jogging. Group exercises may be particularly
beneficial in community building for male participants, who tend
to incline towards physical activity [44], and for quieter group
members who may not engage as often in group conversations.
Ideally, exercise classes will include aerobic, strength-based, and
stretching exercises. To ensure safety, supervision by a profes-
sional fitness instructor is highly recommended.
Virtual support groups, especially those which operate
solely online, have special challenges creating community
and connectedness. Online support groups tend to be more
successful when participants feel seen as unique individuals
and have enough knowledge about their fellow group mem-
bers to also see them as unique individuals [53]. Smaller
groups allow greater time for each member to speak. Use of
both visual and audio during meetings may help foster con-
nection. Group activities may be possible online if they make
use of minimal, commonly available equipment.
19 Page 8 of 11 Curr Cardiovasc Risk Rep (2020) 14: 19
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Conclusion: Future of Peer Support
Weight loss interventions need to be more than just effective at
helping participants lose weight in the short term. A truly suc-
cessful program must support behavior change that can be main-
tained over years rather than weeks. To maintain this sustainabil-
ity, the program must be cost-effective enough that participants
can maintain membership long term and must be able to occa-
sionally reengage in an on-going group when necessary [54].
Peer support groups may help fulfill this function.
Pre-existing online forums may represent a natural medium
for peer support groups, and such venues have several advan-
tages, not the least of which is their accessibility from any
location. Thus far, social media has largely served as a sup-
plement to other active elements within weight loss programs,
such as group educational content or counseling; comparative-
ly, little is known about social medias independent effect
within these programs [55]. Given social mediasubiquity
and popularity, there is great potential there; with social me-
dias well-known ability to propagate misinformation [56,57]
and harmful norms [58], guidance from healthcare profes-
sionals or trained peer coaches may be necessary safeguards.
To summarize, peer-led support groups represent a novel
and potentially effective form of weight loss interventions,
especially when the intervention successfully creates a sense
of shared community among its members. Peer support
groups appear to be particularly effective in supporting vul-
nerable at-risk populations, such as ethnic minorities. The
utility of online peer support as an adjunct to in-person peer
support may not greatly improve short-term study outcomes
but is positively perceived by participants and may improve
long-term adherence.
Compliance with Ethical Standards
Conflict of Interest Kelsey Ufholz declares she has no conflicts of
Human and Animal Rights and Informed Consent This study does not
contain any studies with human or animal subjects performed by the
Open Access This article is licensed under a Creative Commons
Attribution 4.0 International License, which permits use, sharing, adap-
tation, distribution and reproduction in any medium or format, as long as
you give appropriate credit to the original author(s) and the source, pro-
vide a link to the CreativeCommons licence,and indicate if changes were
made. The images or other third party material in this article are included
in the article's Creative Commons licence, unless indicated otherwise in a
credit line to the material. If material is not included in the article's
Creative Commons licence and your intended use is not permitted by
statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this
licence, visit
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... As mentioned above, past literature reviews (Ufholz, 2020;Waring et al., 2018) have not specifically addressed the effects of social support on OHC members. In addition, as noted by Schaefer et al. (1981), it is important to bear in mind that different types of social support can produce different outcomes. ...
... Two other literature reviews (Ufholz, 2020;Waring et al., 2018) adopted a general approach to OHCs, i.e., there was no specific focus on the role played by social support in OHCs in general, or in obesity OHCs in particular. ...
... Social support fostered a sense of responsibility among OHC members (Chancellor et al., 2018;Reading 2016;Naparstek et al., 2017), and one did not refer to obesity OHCs (Shigaki et al., 2014). The other three articles were excluded because they were systematic reviews or did not report data or results that could help respond to the research questions (Ufholz, 2020;Waring et al., 2018;Willmott et al., 2019). ...
Full-text available
In the treatment of obesity, social support is considered key to successful weight loss and behavioural change, and online health communities to complement obesity treatment programmes have been shown to increase obesity treatment effectiveness. This study reviews the latest literature regarding how social support provided through an online health community can help people tackle obesity, identifying the different effects of social support on online health community members, specifically, the promotion of behavioural change and increased self-efficacy. This study also reveals how the recent literature points to both a direct and indirect relationship between social support in online health communities for obesity treatment and actual weight loss. This review is likely to provide useful insights to both healthcare professionals and social platform developers.
... Indeed, Casual Members had the lowest representation in the program's Facebook group. Promoting social network participation may be one way to encourage Casual Members to increase their engagement [30]. Another more personalized possibility could be to pair new members who exhibit Casual Member patterns with a peer support person (e.g., an Enthusiast). ...
... Another more personalized possibility could be to pair new members who exhibit Casual Member patterns with a peer support person (e.g., an Enthusiast). Support from peers with similar lived experiences has been shown to be an effective means of increasing self-efficacy and bolstering engagement [30]. ...
Full-text available
Digital health technologies are shaping the future of preventive health care. We present a quantitative approach for discovering and characterizing engagement personas: longitudinal engagement patterns in a fully digital diabetes prevention program. We used a two-step approach to discovering engagement personas among n = 1613 users: (1) A univariate clustering method using two unsupervised k-means clustering algorithms on app- and program-feature use separately and (2) A bivariate clustering method that involved comparing cluster labels for each member across app- and program-feature univariate clusters. The univariate analyses revealed five app-feature clusters and four program-feature clusters. The bivariate analysis revealed five unique combinations of these clusters, called engagement personas, which represented 76% of users. These engagement personas differed in both member demographics and weight loss. Exploring engagement personas is beneficial to inform strategies for personalizing the program experience and optimizing engagement in a variety of digital health interventions.
... This points to the potential for multicomponent peer support via live video or phone conferencing in addition to online support as worthwhile components for future testing. This is consistent with the current weight loss literature reporting peer group preferences in men [58]. Looking forward, we will adapt this intervention to include more contextually sensitive social support components in a fully powered study. ...
... Both groups in our study achieved averages of ≥3% bodyweight loss from baseline, which is considered as clinically significant weight loss [53,61] [61]. The MT+ group averaged higher percent weight loss at 6 months (see Table 5), suggesting that the enhanced personalization of the MT+ features derived from community-engaged strategies (individualized feedback in several forms and multiple forms of peer support) may be important engagement factors for future interventions [58,60]. Our findings follow a similar pattern described in the weight loss literature. ...
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Background Addressing overweight and obesity among men at-risk for obesity-related diseases and disability in rural communities is a public health issue. Commercial smartphone applications (apps) that promote self-monitoring for weight loss are widely available. Evidence is lacking regarding what support is required to enhance user engagement with and effectiveness of those technologies. Pragmatically comparing these apps effectiveness, including rural men’s desired forms of support when using them, can lead to greater weight loss intervention impact and reach. This study assessed the feasibility and acceptability of a mobile technology application applied differently across two groups for weight loss. Methods In a two-armed, pragmatic pilot feasibility study, 80 overweight and obese men aged 40–69 were randomized using a 1:1 ratio to either an enhanced Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention. The MT+ group had an enhanced smartphone app for self-monitoring (text messaging, discussion group, Wi-Fi scale) whereas the MT group received a basic app that allowed self-monitoring logging only. Assessments were collected at baseline, 3 and 6 months. App logs were analyzed to track engagement and adherence to self-monitoring. Acceptability was assessed via focus groups. Analysis included descriptive statistics and qualitative content analysis. Results Of 80 men recruited, forty were allocated to each arm. All were included in the primary analysis. Recruitment ended after 10 months with a 97.5 and 92.5% (3 month, 6 month) retention rate. Over 90% of men reported via survey and focus groups that Lose-It app and smart scale (MT+) was an acceptable way to self-monitor weight, dietary intake and physical activity. Adherence to daily app self-monitoring of at least 800 dietary calories or more (reported respectively as MT+, MT) was positive with 73.4, 51.6% tracking at least 5 days a week. Adherence to tracking activity via recorded steps four or more days weekly was positive, 87.8, 64.6%. Men also adhered to self-weighing at least once weekly, 64, 46.3%. At 6 months, an observed mean weight loss was 7.03 kg (95% CI: 3.67, 10.39) for MT+ group and 4.14 kg (95% CI: 2.22, 6.06) for MT group, with 42.9 and 34.2% meeting ≥5% weight loss, respectively. No adverse events were reported. Conclusions This National Institutes of Health-funded pilot study using mobile technologies to support behavior change for weight loss was found to be feasible and acceptable among midlife and older rural men. The interventions demonstrated successful reductions in weight, noting differing adherence to lifestyle behaviors of eating, monitoring and activity between groups, with men in the MT+ having more favorable results. These findings will be used to inform the design of a larger scale, clinical trial. Trial registration The trial was prospectively registered with ClinicalTrials NCT03329079 . 11/1/2017.
... Social support is effective for improving weight management [12,13]. A supportive network contributing supportive messages and positive reinforcement can reduce weigh loss [14]. ...
Social isolation and loneliness are growing public health concerns in adults with obesity and overweight. Social media-based interventions may be a promising approach. This systematic review aims to (1) evaluate the effectiveness of social media-based interventions on weight, body mass index, waist circumference, fat, energy intake and physical activity among adults with obesity and overweight and (2) explore potential covariates on treatment effect. Eight databases, namely, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus PsycINFO and ProQuest, were searched from inception until December 31, 2021. The Cochrane Collaboration Risk of Bias Tool and Grading of Recommendations, Assessment, Development and Evaluation criteria evaluated the evidence quality. Twenty-eight randomised controlled trials were identified. Meta-analyses found that social media-based interventions had small-to-medium significant effects on weight, BMI, waist circumference, body fat mass and daily steps. Subgroup analysis found greater effect in interventions without published protocol or not registered in trial registries than their counterparts. Meta-regression analysis showed that duration of intervention was a significant covariate. The certainty of evidence quality of all outcomes was very low or low. Social media-based interventions can be considered an adjunct intervention for weight management. Future trials with large sample sizes and follow-up assessment are needed.
... Community and social support are also documented to assist in weight loss and maintenance. [26] The effect of our ability to create community among participants through interactions and shared experiences may have contributed to the program's success. Further analysis should be performed to assess the role community structure played in perimenopausal participants' results. ...
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Background The transition to menopause is a time when women are at increased risk for chronic and cardiovascular diseases, and weight gain. This study evaluates the efficacy of virtual teaching kitchen (TK) interventions on cooking confidence and consumption of a healthy diet in women over 45. Methods This teaching kitchen intervention is a synchronous online series of classes for perimenopausal women, with 45 min of live cooking and 15 min of nutrition discussion. From September 2020 through January 2022, participants completed online pre- post-intervention surveys addressing weight, eating habits, cooking confidence and self-efficacy. Analysis used paired samples t-test and Wilcoxon signed rank sum test for normally and non-normal distributed data respectively. Results Of the 609 unique participants, 269 women completed both pre and post surveys after attending classes. Participants self-reported a statistically significant decreased weight (p < 0.001), increased daily consumption of fruit/vegetables (p < 0.039), fish (p < 0.001) and beans (p < 0.005), and decreased daily consumption of red meat (p < 0.001), sugary beverages (p < 0.029) and white grains (p < 0.039). There was significant improvement in cooking self-efficacy and confidence. Conclusions Virtual teaching kitchens were effective in improving culinary and dietary habits among peri- and post-menopausal women. This early evidence suggests that teaching kitchens can effectively reach larger populations for healthy behavioral modification. Trial Registration Study obtained IRB exemption.
... The web forums were poorly utilised which limited their potential efficacy. Peer support could potentially be improved by including some visual and audio communication to foster a sense of community and connectivity between users [46]. Weight loss in our written advice group (3.3%) was considerably higher than the 1% previously reported in the literature. ...
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Background: Overweight and obesity are common amongst women attending breast cancer Family History, Risk and Prevention Clinics (FHRPCs). Overweight increases risk of breast cancer (BC) and conditions including1 cardiovascular disease (CVD) and type-2 diabetes (T2D). Clinics provide written health behaviour advice with is likely to have minimal effects. We assessed efficacy of two remotely delivered weight loss programmes vs. written advice. Method: 210 women with overweight or obesity attending three UK FHRPCs were randomised to either a BC prevention programme (BCPP) framed to reduce risk of BC (n = 86), a multiple disease prevention programme (MDPP) framed to reduce risk of BC, CVD and T2D (n = 87), or written advice (n = 37). Change in weight and health behaviours were assessed at 12-months. Results: Weight loss at 12 months was -6.3% (-8.2, -4.5) in BCPP, -6.0% (-7.9, -4.2) in MDPP and -3.3% (-6.2, -0.5) in the written group (p = 0.451 across groups). The percentage losing ≥10% weight in these groups were respectively 34%, 23% and 14% (p = 0.038 across groups). Discussion: BCPP and MDPP programmes resulted in more women achieving ≥10% weight loss, but no evidence of additional benefits of MDPP. A multicentre RCT to test the BCPP across UK FHRPCs is warranted. Clinical Trial Registration ISRCTN16431108.
... This transition has occurred partly out of necessity to extend the reach of treatment services in large rural countries (e.g., Russia; Lyytikäinen, 2016) and these efforts have been hastened globally as a result of the coronavirus disease pandemic (Bergman et al., 2021). Although little is known regarding the effects of meeting in person compared to online, online social groups have emerged as a low-cost, easily accessible, and beneficial resource for a wide range of challenges (Maher et al., 2014) including depression (Breuer & Barker, 2015), grief (Varga & Paulus, 2013), weight loss maintenance (Ufholz, 2020), physical activity (Foster et al., 2010), smoking (Shahab & McEwen, 2009), and substance misuse (Bergman et al., 2017). Other studies have found that online video-based support may be less effective than in-person support for SUD (Barrett & Murphy, 2020) but still are considered an important source of support (Barrett & Murphy, 2020;Kosok, 2006). ...
Objective: Online support groups for individuals with substance use disorders are regularly used, yet little is known about participant engagement patterns. Preliminary research has examined utilization and perceived benefits of an abstinence-focused online social network. This study sought to extend these findings by examining participant characteristics, engagement, and perceived benefits of online support groups for individuals with broader personal substance use goals (Harm reduction, Abstinence, and Moderation Support [HAMS]). Method: HAMS members were invited to complete an online survey about their HAMS engagement (N = 343). The average age of participants was 41.55 (SD = 12.61) and most identified as White (93.9%), female (78.8%), and cisgender women (70.1%). Participants completed measures of HAMS participation, substance use goal, quantity/frequency of substance use, mental health history, negative substance use-related consequences, and quality of life. Results: Most participants (67.1%) reported a substance use moderation goal and alcohol was the most commonly used substance (91.6%). Participants most frequently reported visiting HAMS on Facebook (89.5%), visiting HAMS daily (39.2%), and visits typically lasted up to 30 min (86.1%). Most participants somewhat or strongly agreed HAMS helped them feel better about changing their use of drugs/alcohol (87.1%; M = 4.41/5; SD = 0.81), increased their motivation for changing their use of drugs/alcohol (89.2%; M = 4.44/5; SD = 0.77), and increased their self-efficacy in reaching/maintaining the substance use goals (85.1%; M = 4.29/5; SD = 1.05). Conclusions: Online support for broader personal substance use goals may be beneficial for individuals who seek to stop/limit their substance use. Online support is well suited for obtaining quick, inexpensive access to support. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Plant-based diets may positively impact body composition and cardiometabolic risk factors. An online 8-week plant-based dietary and lifestyle worksite intervention was implemented in spring 2021 among staff ( n = 52) at a public university in the southwestern United States. Participants attended weekly online small group counseling sessions and healthy living workshops with cooking classes. All measures and fasting blood draws were completed at baseline and 8-week post-intervention with changes analyzed using paired sample t-tests. Multiple linear regressions examined associations among knowledge gained and online attendance with outcomes. Results from paired sample t-tests indicated numerous statistically significant improvements from baseline to 8-week post-intervention: total cholesterol (mg/dL) (M BL = 193 ± 39, M PI = 176 ± 36), low-density lipoprotein cholesterol (LDL-C) (mg/dL) (M BL = 110 ± 33, M PI = 98 ± 30), body mass index (BMI) (kg/m 2 ) (M BL = 26.3 ± 6.3, M PI = 25.9 ± 6.1), fat mass (lb) (M BL = 62.0 ± 29.4, M PI = 60.3 ± 28.4), fat-free mass (lb) (M BL = 104.1 ± 29.4, M PI = 102.4 ± 19.6), phase angle (M BL = 5.1 ± .6, M PI = 5.0 ± .6), and diet quality (M BL = 62.4 ± 12.5, M PI = 75.2 ± 10.3). High-density lipoprotein cholestero l(HDL-C) decreased significantly (M BL = 65 ± 18, M PI = 61 ± 18). Knowledge negatively predicted LDL-C (B = −.226, P = .048) and positively predicted diet quality (B = .155, P = .021). Attendance at group sessions positively predicted phase angle (B = .055, P = .038). Findings demonstrate how a plant-based lifestyle can improve cardiometabolic health by reducing risk factors for chronic disease and enhancing body composition. Clinicians can support patients by encouraging plant-based diets.
Objective: The purpose of this study was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) intervention for improving competency and behaviors related to diet, physical activity, and weight management. Methods: Participants with psychiatric disabilities were recruited from four community mental health agencies and a hospital-based psychiatric outpatient clinic and randomly assigned to the NEW-R intervention (N=55) or control condition (N=58). Outcome measures included the Perceived Competence Scale, Health-Promoting Lifestyle Profile (HPLP), and weight change; random-effects regression models were used. A follow-up analysis examined the interactions of group, time, and site. Results: Fifty of the 55 intervention participants and 57 of the 58 control participants completed the study. The two groups did not differ significantly on any measured baseline characteristic. The intervention group had statistically significant improvements, compared with the control group, in perceived competence for exercise and healthy eating, total HPLP score, and scores on two HPLP subscales (nutrition and spiritual growth). No significant difference between groups was found for weight loss. A study condition × time × site effect was observed: at the three sites where mean weight loss occurred, NEW-R participants lost significantly more weight than did control participants. Conclusions: NEW-R offers promise as an intervention that can initiate the change to healthy lifestyle behaviors and boost perceived competence in a healthy lifestyle. It may also be effective for weight loss when administered in supportive settings.
Obesity is a prevalent progressive and relapsing disease for which there are several levels of intervention, including metabolic and bariatric surgery (MBS) and now endoscopic bariatric and metabolic therapies (EBMTs). Preoperative psychological assessment focused on cognitive status, psychiatric symptoms, eating disorders, social support, and substance use is useful in optimizing patient outcomes and minimizing risks in MBS. Very little is known about the psychosocial needs of patients seeking EBMTs, though these investigations will be forthcoming if these therapies become more widespread. As MBS and EBMT inherently alter the gastrointestinal (GI) tract, considerations for the longer-term GI functioning of the patient are relevant and should be considered and monitored.
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Background Support groups are an integral part of bariatric surgery (BS) programs yet there is limited evidence for an association between support group attendance and BS weight outcomes. Settings University Hospital, Spain. Objectives This study examined the effect of support group attendance on weight loss (WL) at short- and long-term follow-up (FU) following BS. Methods Participants were 531 (mean body mass index (BMI) = 45.8 (5.4) kg/m²; mean age 45.9 (11.1) years, 76.4% females) who underwent BS (Roux-en-Y gastric bypass (RYGB): 233 (43.8%); sleeve gastrectomy (SG): 298 (56.2%)) in our clinic. The bariatric support group program (BSGP) consisted of two subprograms: Novel-BSGP (N-BSGP; first 12 months after surgery) and Experienced-BSGP (E-BSGP; FU between 12 months 5 years after BS). Results Three hundred and twenty-three (60.8%) and 129 (24.3%) participants attended at least one session of N-BSGP and E-BSGP, respectively. Linear regression analyses showed that number of sessions attended during year 1 predicted percent total body WL (%TBWL (β = 0.381, p < 0.001)) and percent excess WL (%EWL (β = 0.928, p < 0.001)) at one year and number of sessions attended during years 2–5 were positively related to %TBWL and %EWL achieved at 5 years (%EWL: β = 0.162 (p = 0.014) and %TBWL: β = 0.378 (p = 0.013)) respectively. Conclusion We observed a significant beneficial effect of a post-surgical support group program on short- and long-term body WL after BS.
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Contemporary commentators describe the current period as "an era of fake news" in which misinformation, generated intentionally or unintentionally, spreads rapidly. Although affecting all areas of life, it poses particular problems in the health arena, where it can delay or prevent effective care, in some cases threatening the lives of individuals. While examples of the rapid spread of misinformation date back to the earliest days of scientific medicine, the internet, by allowing instantaneous communication and powerful amplification has brought about a quantum change. In democracies where ideas compete in the marketplace for attention, accurate scientific information, which may be difficult to comprehend and even dull, is easily crowded out by sensationalized news. In order to uncover the current evidence and better understand the mechanism of misinformation spread, we report a systematic review of the nature and potential drivers of health-related misinformation. We searched PubMed, Cochrane, Web of Science, Scopus and Google databases to identify relevant methodological and empirical articles published between 2012 and 2018. A total of 57 articles were included for full-text analysis. Overall, we observe an increasing trend in published articles on health-related misinformation and the role of social media in its propagation. The most extensively studied topics involving misinformation relate to vaccination, Ebola and Zika Virus, although others, such as nutrition, cancer, fluoridation of water and smoking also featured. Studies adopted theoretical frameworks from psychology and network science, while co-citation analysis revealed potential for greater collaboration across fields. Most studies employed content analysis, social network analysis or experiments, drawing on disparate disciplinary paradigms. Future research should examine susceptibility of different sociodemographic groups to misinformation and understand the role of belief systems on the intention to spread misinformation. Further interdisciplinary research is also warranted to identify effective and tailored interventions to counter the spread of health-related misinformation online.
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Objectives. There is solid evidence that risk for developing type 2 diabetes can be prevented by lifestyle interventions. However, there are few diabetes prevention programs available. Given the increasing prevalence of prediabetes, we sought to investigate if a commercial weight loss program with significant capacity could address this need. This study, conducted in Indianapolis, Indiana in 2014–16, investigated if (Weight Watchers- WW) could cost effectively achieve and sustain sufficient weight loss in persons with prediabetes to reduce diabetes risk for 24 months. Methods. A previous, randomized controlled trial evaluated the effectiveness of the WW program in 225 persons with prediabetes as determined by an HbA1c value >5.7% and ≤ 6.4% or a self-reported history of gestational diabetes with an HbA1c <6.5% and/or casual capillary blood glucose (CCBG) <199 mg/dL on weight and metabolic regulation compared with a self-initiated program developed by the National Diabetes Education Program over a 12-month study period. This continuation study assessed outcomes at 18 and 24 months and also evaluated cost effectiveness at 12 and 24 months from a third-party payer perspective. Since this study used a cross over design in which control subjects were provided access to the WW program from 12-24 months, they were no longer randomized. Results. Intervention participants lost significantly more weight than the controls both at 18 (-5.1% vs -1.8%, p ≤ .008)- and 24-months (-4.5% vs -1.8%, p ≤.032 ). Although both groups showed some improvement in CVD risk factors, the only significant difference between groups was that WW participants had greater reductions than controls in HbA1c at both 18 (-0.27 vs -0.17; p =.03) and 24 months (-0.3 vs -0.2; p =.04). Converting the weight loss into quality adjusted life years saved (QALYs) yielded an incremental cost effectiveness ratio (ICER) of $19,034 per QALY gained for the intervention. Sensitivity analyses showed the ICER was well below commonly accepted thresholds for cost effectiveness. Conclusion. These data suggest that evidence-based, widely available weight management programs have the potential to cost effectively improve health outcomes for patients with prediabetes. Given their affordability and scalability, increasing access could result in a significant public health impact.
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Background: Peer support by persons affected with diabetes improves peer supporter's diabetes self-management skills. Peer support interventions by individuals who have diabetes or are affected by diabetes have been shown to improve glycemic control; however, its effects on other cardiovascular disease risk factors in adults with diabetes are unknown. We aimed to estimate the effect of peer support interventions on cardiovascular disease risk factors other than glycemic control in adults with diabetes. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials comparing peer support interventions to a control condition in adults affected by diabetes that measured any cardiovascular disease risk factors [Body Mass Index, smoking, diet, physical activity, cholesterol level, glucose control and blood pressure]. Quality was assessed by Cochrane's risk of bias tool. We calculated standardized mean difference effect sizes using random effects models. Results: We retrieved 438 citations from multiple databases including OVID MEDLINE, Cochrane database and Scopus, and author searches. Of 233 abstracts reviewed, 16 articles met inclusion criteria. A random effects model in a total of 3243 participants showed a positive effect of peer support interventions on systolic BP with a pooled effect size of 2.07 mmHg (CI 0.35 mmHg to 3.79 mmHg, p = 0.02); baseline pooled systolic blood pressure was 137 mmHg. There was a non-significant effect of peer support interventions on diastolic blood pressure, cholesterol, body mass index, diet and physical activity. Cardiovascular disease risk factors other than glycemic control outcomes were secondary outcomes in most studies and baseline values were normal or mildly elevated. Only one study reported smoking outcomes. Conclusions: We found a small (2 mmHg) positive effect of peer support interventions on systolic blood pressure in adults with diabetes whose baseline blood pressure was on average minimally elevated. Additional studies need to be conducted to further understand the effect of peer support interventions on high-risk cardiovascular disease risk factors in adults with diabetes.
Obesity is associated with serious health risks (1). Severe obesity further increases the risk of obesity-related complications, such as coronary heart disease and end-stage renal disease (2,3). From 1999-2000 through 2015-2016, a significantly increasing trend in obesity was observed (4). This report provides the most recent national data for 2017-2018 on obesity and severe obesity prevalence among adults by sex, age, and race and Hispanic origin. Trends from 1999-2000 through 2017-2018 for adults aged 20 and over are also presented.
Objective: To explore how men's social relationships influence their dietary, physical activity, and weight loss intentions and behaviors. Design: Qualitative study using semistructured interviews. Setting: One county in the southwest of England. Participants: Men (n = 19) aged 18-60 years with a body mass index ≥24 kg/m2 who were otherwise healthy. Phenomenon of interest: Men's perceptions of dieting, physical activity and weight loss, and how social relationships influence these behaviors. Analysis: Interviews were audiorecorded and transcribed verbatim. Transcripts were coded line by line using NVivo software. Themes and subthemes were inductively generated using thematic analysis. Results: Four themes were derived: (1) how experiences shape beliefs, (2) being a proper bloke, (3) adapting to family life, and (4) support from outside the home. Men discussed how partners were a greater influence on diet than physical activity. Attitudes toward diet and physical activity were influenced by life events such as becoming a father. It was framed as acceptable for men to talk to their friends about exercise and food intake in general, but they emphasized that this was not for "support." Conclusions and implications: Family members were key influences on men's behaviors. Future qualitative research could include interviews with men's families. Findings may inform family weight loss interventions.
The ubiquitous social media landscape has created an information ecosystem populated by a cacophony of opinion, true and false information, and an unprecedented quantity of data on many topics. Policy makers and the social media industry grapple with the challenge of curbing fake news, disinformation, and hate speech; and the field of medicine is similarly confronted with the spread of false, inaccurate, or incomplete health information.
Objective: A national cardiometabolic screening program for patients in a variety of public mental health facilities, group practices, and community behavioral health clinics was funded by Pfizer Inc. between 2005 and 2008. Methods: A one-day, voluntary metabolic health fair in the United States offered patients attending public mental health clinics free cardiometabolic screening and same-day feedback to physicians from a biometrics testing third party that was compliant with the Health Insurance Portability and Accountability Act. Results: This analysis included 10,084 patients at 219 sites; 2,739 patients (27%) reported having fasted for over eight hours. Schizophrenia or bipolar disorder was self-reported by 6,233 (62%) study participants. In the overall sample, the mean waist circumference was 41.1 inches for men and 40.4 inches for women; 27% were overweight (body mass index [BMI] 25.0-29.9 kg/m2), 52% were obese (BMI ≥30.0 kg/m²), 51% had elevated triglycerides (≥150 mg/dl), and 51% were hypertensive (≥130/85 mm Hg). In the fasting sample, 52% had metabolic syndrome, 35% had elevated total cholesterol (≥200 mg/dl), 59% had low levels of high-density lipoprotein cholesterol (<40 mg/dl for men or <50 mg/dl for women), 45% had elevated triglycerides (≥150 mg/dl), and 33% had elevated fasting glucose (≥100 mg/dl). Among the 1,359 fasting patients with metabolic syndrome, 60% were not receiving any treatment. Among fasting patients who reported treatment for specific metabolic syndrome components, 33%, 65%, 71%, and 69% continued to have elevated total cholesterol, low levels of high-density lipoprotein, high blood pressure, and elevated glucose levels, respectively. Conclusions: The prevalence of metabolic syndrome and cardiometabolic risk factors, such as overweight, hypertension, dyslipidemia, and glucose abnormalities, was substantial and frequently untreated in this U.S. national mental health clinic screening program.
Obesity is associated with serious health risks. Monitoring obesity prevalence is relevant for public health programs that focus on reducing or preventing obesity. Between 2003–2004 and 2013–2014, there were no significant changes in childhood obesity prevalence, but adults showed an increasing trend. This report provides the most recent national estimates from 2015–2016 on obesity prevalence by sex, age, and race and Hispanic origin, and overall estimates from 1999–2000 through 2015–2016.