Yaguang Zheng

Abstract

Self-monitoring (SM) of food intake is central to weight loss treatment. Technology makes it possible to reinforce this behavior change strategy by providing real-time feedback (FB) tailored to the diary entry. To test the feasibility of providing 1–4 daily FB messages tailored to dietary recordings via a smartphone, we conducted a 12-week pilot randomized clinical trial in Pittsburgh, PA in US in 2015. We compared 3 groups: SM using the Lose It! smartphone app (Group 1); SM + FB (Group 2); and SM + FB + attending three in-person group sessions (Group 3). The sample (N = 39) was mostly white and female with a mean body mass index of 33.76 kg/m2. Adherence to dietary SM was recorded daily, weight was assessed at baseline and 12 weeks. The mean percentage of days adherent to dietary SM was similar among Groups 1, 2, and 3 (p = 0.66) at 53.50% vs. 55.86% vs. 65.33%, respectively. At 12 weeks, all groups had a significant percent weight loss (p < 0.05), with no differences among groups (− 2.85% vs. − 3.14% vs. − 3.37%) (p = 0.95); 26% of the participants lost ≥ 5% of their baseline weight. Mean retention was 74% with no differences among groups (p = 0.37). All groups adhered to SM at levels comparable to or better than other weight loss studies and lost acceptable amounts of weight, with minimal intervention contact over 12 weeks. These preliminary findings suggest this 3-group approach testing SM alone vs. SM with real-time FB messages alone or supplemented with limited in-person group sessions warrants further testing in a larger, more diverse sample and for a longer intervention period.

Abstract

Background: Obesity research has typically focused on weight change patterns using the whole sample in randomized clinical trials (RCTs), ignoring subsets of individuals with varying weight change trajectories (e.g., continuing to lose, or maintaining weight). The purpose was to explore possible trajectories of weight change and their associated predictors. Methods: We conducted a secondary analysis of data from two RCTs using standard behavioral treatment for weight loss. Group-based trajectory modeling was used to identify distinct classes of percent weight change trajectories over 18 months. Results: The sample (N = 338) was primarily female (85.2%), White (73.7 %), 45.7 ± 9.0 years old, with 15.6 ± 2.8 years of education. Three trajectory groups were identified: good responders (>15% weight loss), fair responders (5%–10% weight loss), and poor responders (<5% weight loss). The good responders had a significantly larger decrease in perceived Barriers to Healthy Eating subscale scores than the fair and poor responders (p <.01). Compared to the poor responders, there was a significant decrease in fat gram intake in the good responders (p =.01). Conclusions: Good responders differed from poor responders in decreasing their perceived barriers to healthy eating (e.g., managing emotions, social support, and daily mechanics of adopting a healthy diet) and reducing fat intake. Good responders differed from fair responders in perceived barriers to healthy eating. Clinical Relevance: Clinicians need to focus on how we can assist those who are being unsuccessful in adopting some of the behaviors observed among those who have experienced successful weight loss and maintainers.

Abstract

Background: To date, no investigators have examined electronically recorded self-weighing behavior beyond 9 months or the underlying mechanisms of how self-weighing might impact weight change. Objective: Our aims were to examine electronically recorded self-weighing behavior in a weight-loss study and examine the possible mediating effects of adherence to energy intake and energy expenditure (EE) goals on the association between self-weighing and weight change. Design: This was a secondary analysis of the self-efficacy enhancement arm of the Self Efficacy Lifestyle Focus (SELF) trial, an 18-month randomized clinical trial. Participants/setting: The study was conducted at the University of Pittsburgh (2008-2013). Overweight or obese adults with at least one additional cardiovascular risk factor were eligible. Intervention: Participants in the self-efficacy enhancement arm were given a scale (Carematix, Inc) and instructed to weigh themselves at least 3 days per week or every other day. The scale date- and time-stamped each weighing episode, storing up to 100 readings. Main outcome measures: Weight was assessed every 6 months. Adherence to energy intake and EE goals was calculated on a weekly basis using paper diary data. Statistical analyses performed: Linear mixed modeling and mediation analyses were used. Results: The sample (n=55) was 80% female, 69% non-Hispanic white, mean (standard deviation) age was 55.0 (9.6) years and body mass index (calculated as kg/m2) was 33.1 (3.7). Adherence to self-weighing declined over time (P<0.001). From baseline to 6 months, there was a significant mediation effect of adherence to energy intake (P=0.02) and EE goals (P=0.02) on the association between adherence to self-weighing and percent weight change. Mediation effects were not significant during the second and third 6-month periods of the study. Conclusions: Objectively measured adherence to self-weighing declined over 18 months. During the first 6 months, self-weighing directly impacted weight change and indirectly impacted weight change through changes in energy intake and EE.

Abstract

The prevalence of obesity is a significant problem among racial and ethnic minorities and those of low socioeconomic status (SES). Psychosocial barriers, such as binge eating and low self-efficacy, are known to hinder the adoption of a more healthful diet. There is limited research identifying racial and SES differences in binge eating and self-efficacy. Further investigations of these constructs may allow researchers to improve the effectiveness of weight management interventions and increase social worker involvement. In this article, the authors examine the socioeconomic and racial differences in binge eating and eating self-efficacy in a sample of individuals seeking weight loss treatment (N = 151). They explore associations between various sociodemographic variables and the Binge Eating Scale and Weight Efficacy Lifestyle Questionnaire (WEL). At baseline, nonwhite participants or those with fewer years of education exhibited more confidence resisting eating when food was available. Moreover, nonwhite participants reported more self-confidence eating under social pressure and had higher total WEL scores than white participants. However, at six months, nonwhite participants' WEL scores decreased. White participants increased their total WEL scores and obtained a higher percent weight change by the end of the intervention. Additional investigations on the dynamics affecting the development of self-efficacy are warranted.

Abstract

The purpose of this study was to examine the neighborhood environment and the association with weight change among overweight/obese individuals in the first six months of a 12-month weight loss intervention, EMPOWER, from 2011 to 2015. Measures of the neighborhood environment included neighborhood racial composition, neighborhood income, and neighborhood food retail stores density (e.g., grocery stores). Weight was measured at baseline and 6 months and calculated as the percent weight change from baseline to 6 months. The analytic sample (N = 127) was 91% female and 81% white with a mean age of 51 (± 10.4) years. At 6 months, the mean weight loss was 8.0 kg (± 5.7), which was equivalent to 8.8% (± 6%) of baseline weight. Participants living in neighborhoods in which 25–75% of the residents identified as black had the greatest percentage of weight loss compared to those living in neighborhoods with < 25% or > 75% black residents. No other neighborhood measures were associated with weight loss. Future studies testing individual-level behavioral weight loss interventions need to consider the influence of neighborhood factors, and how neighborhood-level interventions could be enhanced with individual-level interventions that address behaviors and lifestyle changes.

Abstract

Background/Objectives: Regular self-weighing has been associated with weight loss and maintenance in adults enrolled in a behavioral weight loss intervention; however, few studies have examined the patterns of adherence to a self-weighing protocol. The study aims were to (1) identify patterns of self-weighing behavior; and (2) examine adherence to energy intake and step goals and weight change by self-weighing patterns. Subjects/Methods: This was a secondary analysis of self-monitoring and assessment weight data from a 12-month behavioral weight loss intervention study. Each participant was given a scale that was Wi-Fi-enabled and transmitted the date-stamped weight data to a central server. Group-based trajectory modeling was used to identify distinct classes of trajectories based on the number of days participants self-weighed over 51 weeks. Results: The sample (N=148) was 90.5% female, 81.1% non-Hispanic white, with a mean (s.d.) age of 51.3 (10.1) years, had completed an average of 16.4 (2.8) years of education and had mean body mass index of 34.1 (4.6) kg m-2. Three patterns of self-weighing were identified: high/consistent (n=111, 75.0% self-weighed over 6 days per week regularly); moderate/declined (n=24, 16.2% declined from 4-5 to 2 days per week gradually); and minimal/declined (n=13, 8.8% declined from 5-6 to 0 days per week after week 33). The high/consistent group achieved greater weight loss than either the moderate/declined and minimal/declined groups at 6 months (-10.19%±5.78%, -5.45%±4.73% and -2.00%±4.58%) and 12 months (-9.90%±8.16%, -5.62%±6.28% and 0.65%±3.58%), respectively (P<0.001). The high/consistent group had a greater mean number days per week of adherence to calorie intake goal or step goal but not higher than the moderate/declined group. Conclusions: This is the first study to reveal distinct temporal patterns of self-weighing behavior. The majority of participants were able to sustain a habit of daily self-weighing with regular self-weighing leading to weight loss and maintenance as well as adherence to energy intake and step goals.

Abstract

Preventing attrition is a major concern in behavioral weight loss intervention studies. The purpose of this analysis was to identify baseline and six-month predictors associated with participant attrition across three independent clinical trials of behavioral weight loss interventions (PREFER, SELF, and SMART) that were conducted over 10years. Baseline measures included body mass index, Barriers to Healthy Eating, Beck Depression Inventory-II (BDI), Hunger Satiety Scale (HSS), Binge Eating Scale (BES), Medical Outcome Study Short Form (MOS SF-36 v2) and Weight Efficacy Lifestyle Questionnaire (WEL). We also examined early weight loss and attendance at group sessions during the first 6months. Attrition was recorded at the end of the trials. Participants included 504 overweight and obese adults seeking weight loss treatment. The sample was 84.92% female and 73.61% white, with a mean (±SD) age of 47.35±9.75years. After controlling for the specific trial, for every one unit increase in BMI, the odds of attrition increased by 11%. For every year increase in education, the odds of attrition decreased by 10%. Additional predictors of attrition included previous attempts to lose 50-79lbs, age, not possessing health insurance, and BES, BDI, and HSS scores. At 6months, the odds of attrition increased by 10% with reduced group session attendance. There was also an interaction between percent weight change and trial (p<.001). Multivariate analysis of the three trials showed education, age, BMI, and BES scores were independently associated with attrition (ps≤.01). These findings may inform the development of more robust strategies for reducing attrition.

Abstract

Objective: To examine longitudinal changes in perceptions of barriers to healthy eating and its impact on dietary intake and weight loss in a 24-month trial. Methods: A secondary analysis was conducted using data from a behavioral weight loss trial (n = 210). The Barriers to Healthy Eating (BHE) scale was used to measure perceived barriers to healthy eating. Weight, total energy, and fat intake were measured. Longitudinal mixed regression modeling was used for data analysis. Results: The BHE total score decreased from baseline to 6 months and increased slightly from 6 to 24 months (P <.001). Changes in BHE total and subscale scores were positively associated with changes in total energy and fat intake (P <.05) as well as weight (P <.01). Conclusions and Implications: Reducing barriers could lead to improved short-term dietary changes and weight loss. Innovative strategies need to be developed to prevent barriers from increasing when intervention intensity begins to decrease.

Abstract

Background: The present study was designed to implement an interprofessional simulation-based education program for nursing students and evaluate the influence of this program on nursing students' attitudes toward interprofessional education and knowledge about operating room nursing. Methods: Nursing students were randomly assigned to either the interprofessional simulation-based education or traditional course group. A before-and-after study of nursing students' attitudes toward the program was conducted using the Readiness for Interprofessional Learning Scale. Responses to an open-ended question were categorized using thematic content analysis. Nursing students' knowledge about operating room nursing was measured. Results: Nursing students from the interprofessional simulation-based education group showed statistically different responses to four of the nineteen questions in the Readiness for Interprofessional Learning Scale, reflecting a more positive attitude toward interprofessional learning. This was also supported by thematic content analysis of the open-ended responses. Furthermore, nursing students in the simulation-based education group had a significant improvement in knowledge about operating room nursing. Conclusions: The integrated course with interprofessional education and simulation provided a positive impact on undergraduate nursing students' perceptions toward interprofessional learning and knowledge about operating room nursing. Our study demonstrated that this course may be a valuable elective option for undergraduate nursing students in operating room nursing education.