Outcomes of a 12-month web-based intervention for overweight and obese men.

BACKGROUND: This study assessed the effect of a 1-year internet-based weight loss intervention for men. METHODS: Four hundred forty-one overweight and obese men were randomized to intervention or delayed treatment. Participants completed a Web-based assessment of diet and physical activity behaviors and weekly tailored Web modules addressing weight-related behaviors. RESULTS: At 12 months compared to controls, intervention men decreased percent of energy from saturated fat and increased grams of fiber and fruit/vegetable servings per 1.000 kcal (p values < 0.001) and walked 16 min more per day (p < 0.05). No between-group differences in body mass index (BMI), weight, or waist circumference were seen, but among completers, men in the highest tertile of intervention participation had lower weight (98.74 vs. 102.37 kg), BMI (32.38 vs. 33.46), and waist circumference (42.17 vs. 43.47 cm) compared to men who participated less often. CONCLUSIONS: The intervention improved diet and activity behaviors, but weight loss occurred only for those with the highest adherence.

A review of eHealth interventions for physical activity and dietary behavior change.

OBJECTIVE: To review eHealth intervention studies for adults and children that targeted behavior change for physical activity, healthy eating, or both behaviors. DATA SOURCES: Systematic literature searches were performed using five databases: MEDLINE, PsychInfo, CINAHL, ERIC, and the Cochrane Library to retrieve articles. STUDY INCLUSION AND EXCLUSION CRITERIA: Articles published in scientific journals were included if they evaluated an intervention for physical activity and/or dietary behaviors, or focused on weight loss, used randomized or quasi-experimental designs, measured outcomes at baseline and a follow-up period, and included an intervention where participants interacted with some type of electronic technology either as the main intervention or an adjunct component. All studies were published between 2000 and 2005. RESULTS: Eighty-six publications were initially identified, of which 49 met the inclusion criteria (13 physical activity publications, 16 dietary behaviors publications, and 20 weight loss or both physical activity and diet publications), and represented 47 different studies. Studies were described on multiple dimensions, including sample characteristics, design, intervention, measures, and results. eHealth interventions were superior to comparison groups for 21 of 41 (51%) studies (3 physical activity, 7 diet, 11 weight loss/physical activity and diet). Twenty-four studies had indeterminate results, and in four studies the comparison conditions outperformed eHealth interventions. CONCLUSIONS: Published studies of eHealth interventions for physical activity and dietary behavior change are in their infancy. Results indicated mixed findings related to the effectiveness of eHealth interventions. Interventions that feature interactive technologies need to be refined and more rigorously evaluated to fully determine their potential as tools to facilitate health behavior change.

Patterns of sedentary behavior among adolescents.

OBJECTIVE: Reducing certain sedentary behaviors (e.g., watching television, using a computer) can be an effective weight loss strategy for youth. Knowledge about whether behaviors cluster together could inform interventions. STUDY DESIGN: Estimates of time spent in 6 sedentary behaviors (watching television, talking on the telephone, using a computer, listening to music, doing homework, reading) were cluster analyzed for a sample of 878 adolescents (52% girls, mean age = 12.7 years, 58% Caucasian). MAIN OUTCOME MEASURES: The clusters were based on the sedentary behaviors listed above and compared on environmental variables (e.g., household rules), psychosocial variables (e.g., self-efficacy, enjoyment), and health behaviors (e.g., physical activity, diet). RESULTS: Four clusters emerged: low sedentary, medium sedentary, selective high sedentary, and high sedentary. Analyses revealed significant cluster differences for gender (p < .002), age (p < .002), body mass index (p < .001), physical activity (p < .01), and fiber intake (p < .01). CONCLUSIONS: Results suggest a limited number of distinct sedentary behavior patterns. Further study is needed to determine how interventions may use cluster membership to target segments of the adolescent population.

Psychosocial correlates of dietary intake among overweight and obese men.

OBJECTIVES: To investigate the relationship between theoretically based psychosocial constructs and dietary components among overweight men. METHODS: Participants were 441 men (BMI M = 34.2). Psychosocial constructs included self-efficacy, decisional balance, social support, and behavior change strategies. Dietary components were fat, fiber, and fruit and vegetable intake. RESULTS: All significant findings were in the expected direction. Multiple regression models indicated that the psychosocial factors accounted for the most variance in vegetable intake (R(2)=.13) and the least variance in fat (R(2)=.05). CONCLUSIONS: Theoretically based psychosocial constructs were related to overweight men's dietary intake and have potential for use in tailored behavior-change interventions.

Randomized controlled trial of a primary care and home-based intervention for physical activity and nutrition behaviors: PACE+ for adolescents.

OBJECTIVE: Many adolescents do not meet national guidelines for participation in regular moderate or vigorous physical activity (PA); limitations on sedentary behaviors; or dietary intake of fruits and vegetables, fiber, or total dietary fat. This study evaluated a health care-based intervention to improve these behaviors. DESIGN: Randomized controlled trial. SETTING: Primary care with follow-up at home. PARTICIPANTS: Eight hundred seventy-eight adolescent girls and boys aged 11 to 15 years. INTERVENTIONS: Two experimental conditions: (1) Primary care, office-based, computer-assisted diet and PA assessment and stage-based goal setting followed by brief health care provider counseling and 12 months of monthly mail and telephone counseling and (2) a comparison condition addressing sun exposure protection. MAIN OUTCOME MEASURES: Minutes per week of moderate plus vigorous PA measured by self-report and accelerometer; self-report of days per week of PA and sedentary behaviors; and percentage of energy from fat and servings per day of fruits and vegetables measured by three 24-hour diet recalls. Body mass index (calculated as weight in kilograms divided by the square of height in meters) was a secondary outcome. RESULTS: Compared with adolescents in the sun protection condition, girls and boys in the diet and PA intervention significantly reduced sedentary behaviors (intervention vs control change, 4.3 to 3.4 h/d vs 4.2 to 4.4 h/d for girls, respectively [P = .001]; 4.2 to 3.2 h/d vs 4.2 to 4.3 h/d for boys, respectively [P = .001]). Boys reported more active days per week (intervention vs control change: 4.1 to 4.4 d/wk vs 3.8 to 3.8 d/w, respectively [P = .01]), and the number of servings of fruits and vegetables for girls approached significance (intervention vs control change, 3.5 to 4.2 servings/d vs 3.5 to 3.9 servings/d, respectively [P = .07]). No intervention effects were seen with percentage of calories from fat or minutes of PA per week. Percentage of adolescents meeting recommended health guidelines was significantly improved for girls for consumption of saturated fat (intervention vs control change, 23.4% to 41.0% vs 18.5% to 31%, respectively [relative risk, 1.33; 95% confidence interval, 1.01-1.68]) and for boys' participation in d/wk of PA (intervention vs control change, 45.3% to 55.4% vs 41.9% to 38.0%, respectively [relative risk, 1.47; 95% confidence interval, 1.19-1.75]). No between-group differences were seen in body mass index. CONCLUSIONS: Improvements in some diet, PA, and sedentary behaviors in adolescents can be enabled through the use of a 1-year, integrated intervention using the computer, health provider counseling, mail, and telephone. The amount of intervention received may contribute to its efficacy.

Psychosocial correlates of fruit, vegetable, and dietary fat intake among adolescent boys and girls.

OBJECTIVE: This study examined whether hypothesized psychosocial correlates of behavior change (family/peer influence, pros, cons, self-efficacy, parent/child change strategies, and household eating rules) are associated with consumption of fruits, vegetables, and dietary fat among adolescent boys and girls. DESIGN: This cross-sectional study used questionnaires to assess psychosocial variables and multiple 24-hour recall interviews to assess dietary intake (daily servings of fruits and vegetables and percentage energy intake from dietary fat). SUBJECTS: In this study, 878 adolescents (53.6% female, 57.9% white, mean age 12.8 years, age range 11 to 15 years) completed questionnaires. STATISTICAL ANALYSES PERFORMED: Hierarchical linear regressions were conducted on the entire sample as well as on subgroups based on sex and age (young/old). RESULTS: Results indicated that child behavior change strategies, decisional balance, and household rules were related to percentage energy intake from total fat, whereas child behavior change strategies, family influence, and household rules were related to daily servings of fruit and vegetables. More psychosocial correlates were found for older than for younger adolescents. CONCLUSIONS: Both psychological and social correlates of adolescent eating behaviors were identified, and correlates differed somewhat by adolescent subgroup. Based on these findings, promising intervention strategies that include the following should be evaluated: helping adolescents alter decisional balance, teaching behavior-change strategies, and helping parents support children's dietary changes and institute supportive household rules.

An ecological framework for cancer communication: implications for research.

The field of cancer communication has undergone a major revolution as a result of the Internet. As recently as the early 1990s, face-to-face, print, and the telephone were the dominant methods of communication between health professionals and individuals in support of the prevention and treatment of cancer. Computer-supported interactive media existed, but this usually required sophisticated computer and video platforms that limited availability. The introduction of point-and-click interfaces for the Internet dramatically improved the ability of non-expert computer users to obtain and publish information electronically on the Web. Demand for Web access has driven computer sales for the home setting and improved the availability, capability, and affordability of desktop computers. New advances in information and computing technologies will lead to similarly dramatic changes in the affordability and accessibility of computers. Computers will move from the desktop into the environment and onto the body. Computers are becoming smaller, faster, more sophisticated, more responsive, less expensive, and--essentially--ubiquitous. Computers are evolving into much more than desktop communication devices. New computers include sensing, monitoring, geospatial tracking, just-in-time knowledge presentation, and a host of other information processes. The challenge for cancer communication researchers is to acknowledge the expanded capability of the Web and to move beyond the approaches to health promotion, behavior change, and communication that emerged during an era when language- and image-based interpersonal and mass communication strategies predominated. Ecological theory has been advanced since the early 1900s to explain the highly complex relationships among individuals, society, organizations, the built and natural environments, and personal and population health and well-being. This paper provides background on ecological theory, advances an Ecological Model of Internet-Based Cancer Communication intended to broaden the vision of potential uses of the Internet for cancer communication, and provides some examples of how such a model might inform future research and development in cancer communication.

Diet, physical activity, and sedentary behaviors as risk factors for overweight in adolescence.

BACKGROUND: The proportion of overweight adolescents has increased, but the behavioral risk factors for overweight youth are not well understood. OBJECTIVE: To examine how diet, physical activity, and sedentary behaviors relate to overweight status in adolescents. DESIGN AND SETTING: Baseline data from the Patient-Centered Assessment and Counseling for Exercise Plus Nutrition Project, a randomized controlled trial of adolescents to determine the effects of a clinic-based intervention on physical activity and dietary behaviors. PARTICIPANTS: A total of 878 adolescents aged 11 to 15 years, 42% of whom were from minority backgrounds. MAIN OUTCOME MEASURE: Centers for Disease Control and Prevention body mass index-for-age percentiles divided into 2 categories: normal weight (<85th percentile) and at risk for overweight plus overweight (AR + O) (>or=85th percentile). RESULTS: Overall, 45.7% of the sample was classified as AR + O with a body mass index for age at the 85th percentile or higher. More girls from minority backgrounds (54.8%) were AR + O compared with non-Hispanic white girls (42%) (chi(2)(1) = 7.6; P =.006). Bivariate analyses indicated that girls and boys in the AR + O group did fewer minutes per day of vigorous physical activity, consumed fewer total kilojoules per day, and had fewer total grams of fiber per day than those in the normal-weight group. Boys in the AR + O group also did fewer minutes per day of moderate physical activity and watched more minutes per day of television on nonschool days than normal-weight boys. Final multivariate models indicated that independent of socioeconomic status (as assessed by household education level), girls had a greater risk of being AR + O if they were Hispanic or from another minority background (odds ratio [OR] = 1.65; 95% confidence interval [CI], 1.09-2.49) and a reduced risk of being AR + O as minutes per day of vigorous physical activity increased (OR = 0.93; 95% CI, 0.89-0.97). A low level of vigorous physical activity was the only significant risk factor for boys being AR + O (OR = 0.92; 95% CI, 0.89-0.95). Analyses based on meeting behavioral guidelines supported these findings and showed that failing to meet the 60 min/d moderate to vigorous physical activity guideline was associated with overweight status for both girls and boys. In addition, boys who failed to meet sedentary behavior and dietary fiber guidelines were more likely to be overweight. CONCLUSIONS: Of the 7 dietary and physical activity variables examined in this cross-sectional study, insufficient vigorous physical activity was the only risk factor for higher body mass index for adolescent boys and girls. Prospective studies are needed to clarify the relative importance of dietary and physical activity behaviors on overweight in adolescence.

An interactive psychoeducational intervention for women at risk of developing an eating disorder.

This study evaluated a synchronous Internet-delivered intervention (chat room) for improving eating habits and body image in college-age women at risk for developing an eating disorder. Sixty at-risk women (mean age = 18.9, SD = 2.4; 65.0% Caucasian, 19% Latino/Hispanic, 8% Asian/Pacific Islander, 3% African American, 5% other; mean body mass index = 25.6, SD = 5.7) were randomly assigned to intervention (n = 30) or control (n = 30) groups. Once a week for 8 weeks, participants used a private chat room for a 1-hr moderated discussion focused on improving body image and eating behaviors. Additional treatment components included psychoeducation, asynchronous support, homework, and summaries. Assessments were conducted at baseline, posttreatment, and 10 weeks after posttreatment. Participants indicated high satisfaction with the intervention mode. Intervention participants significantly reduced eating pathology and improved self-esteem over controls at follow-up. These findings suggest that synchronous, Internet-delivered programs are efficacious and have potential to reduce problematic attitudes and behaviors that may lead to eating disorders among college-age women.

Body image and self-esteem among adolescents undergoing an intervention targeting dietary and physical activity behaviors.

PURPOSE: To determine the effect of a one-year intervention targeting physical activity, sedentary, and diet behaviors among adolescents on self-reported body image and self-esteem. Health promotion interventions can lead to awareness of health risk and subsequent adoption of beneficial changes in behavior. However, it is possible that interventions targeting behaviors associated with childhood obesity may also increase the likelihood of unhealthy eating and physical activity obsessions and behaviors. METHODS: Body image and self-esteem were assessed for adolescents participating in the PACE+ study, a randomized controlled trial of a 1-year behavioral intervention targeting physical activity, sedentary, and dietary behaviors. The Body Dissatisfaction subscale of the Eating Disorder Inventory and Rosenberg Self-Esteem scale were used to assess body image and self-esteem, respectively, and measurements were performed at baseline, and at 6 and 12 months. Demographic characteristics and weight status of participants were also ascertained. Analysis of responses was performed via both between-group and within-group repeated measure analyses. RESULTS: There were 657 adolescents who completed all measurements. Body image differences were found for age, gender, and weight status at baseline, whereas self-esteem differences were demonstrated for gender, ethnicity, and weight status. There were no intervention effects on body image or self-esteem for either girls or boys. Self-esteem and body satisfaction did not worsen as a result of participating in the PACE+ intervention for either boys or girls whether or not they lost or maintained their weight or gained weight. Girls assigned to the PACE intervention who experienced weight reduction or weight maintenance at either 6 or 12 months reported improvements in body image satisfaction (p = .02) over time compared with subjects who had experienced weight gain during the 12-month study period. CONCLUSIONS: Adverse effects on body satisfaction and self-esteem were not observed among adolescents undergoing this behavioral intervention. These results suggest that a behavioral intervention directed at improving physical activity and diet habits may be safely undertaken by adolescents, including those who are overweight and at risk for overweight, without adverse psychological consequences. Inclusion of specific elements in the intervention that directly addressed body image and self-esteem issues may have reduced the risk for negative psychological effects.

Prevalence, characteristics, and correlates of teasing experiences among overweight children vs. non-overweight peers.

OBJECTIVE: Information regarding the prevalence, nature, sources, and psychosocial correlates of teasing was obtained for overweight (OV) children (10 to 14 years of age) vs. non-overweight (non-OV) peers. It was hypothesized that weight-related teasing would be negatively correlated with self-esteem in specific domains and with enjoyment of physical/social activities and positively correlated with loneliness, bulimic behaviors, body dissatisfaction, and enjoyment of sedentary/isolative activities. RESEARCH METHODS AND PROCEDURES: Teasing experiences and psychosocial correlates were assessed among OV children from a fitness camp and a demographically similar school sample of non-OV children. RESULTS: Among the OV children, appearance-related teasing was more prevalent, frequent, and upsetting, involved disparaging nicknames focusing more on weight rather than less stigmatized aspects of appearance, and more often perpetrated by peers in general rather than a specific peer. Degree of teasing within the full sample was significantly associated with higher weight concerns, more loneliness, poorer self-perception of one's physical appearance, higher preference for sedentary/isolative activities, and lower preference for active/social activities, all but the latter association holding up above and beyond actual weight status and demographics. Among OV children, teasing was associated with bulimic behaviors. Associations with type of teasing showed specificity, with weight-related teasing predicting weight and appearance variables and competency-related teasing related to social domain factors. DISCUSSION: When frequency, intensity, emotional impact, and stigmatized content are examined, findings indicate that teasing is more severe for OV children. Effective interventions are needed to help victims cope with and prevent further weight-related teasing, which may improve peer functioning, enhance weight control efforts, and reduce risk for future eating disturbance.

Computer and Internet applications for psychological treatment: update for clinicians.

Computers and the Internet have the potential to be used to deliver psychological treatments. This article provides a selective review of applications involving little or no therapist contact, applications involving asynchronous and synchronous communication with providers, and applications that have been used as adjuncts to standard psychotherapy. Data on the efficacy of these applications most strongly support using the Internet to complete and submit behavioral assignments, to obtain social support from peers, and to receive education, feedback, and support from therapists in the form of e-mail or chatroom communications. General practice recommendations are given with an emphasis on ways to encourage use of the Internet as an information and communication tool as an adjunct to regular psychotherapy.

Prevention of eating disorders and obesity via the internet.

Internet technology has been expanding rapidly and has had a dramatic impact on how people communicate, learn and share information. This article presents applications of internet technology to the psychological domain, particularly in the prevention and treatment of eating disorders and obesity. Information regarding advantages and disadvantages of computerized interventions are discussed and several examples of randomized controlled trials with this technology are presented. The studies presented are not meant to be comprehensive of psychological interventions in general, but are examples of computerized applications from the eating disorder and obesity literatures. Ethical considerations and areas for future direction are also discussed.

Overweight children's barriers to and support for physical activity.

OBJECTIVE: As the epidemic of overweight increases among youth, research needs to examine factors that may influence children's participation in weight-related health behaviors. This study examined overweight children's perceived barriers to and support for physical activity compared with nonoverweight children. RESEARCH METHODS AND PROCEDURES: Barriers to and support for physical activity were examined among 84 overweight children attending a summer fitness camp or a university-based weight loss clinic. Barriers and support levels were then compared with those of 80 nonoverweight children of a similar age range. RESULTS: Body-related barriers were the most predominant barrier type among overweight youth, especially among overweight girls. Overweight children, particularly girls, reported significantly higher body-related, resource, and social barriers to physical activity compared with nonoverweight children and lower levels of adult support for physical activity. DISCUSSION: Overweight children may be particularly vulnerable to body-related barriers to physical activity, and reducing such barriers may serve as physical activity intervention points most relevant for overweight youth. Future interventions may also benefit from enhancing support for physical activity from adults and peers.

Preliminary evaluation of a multicomponent program for nutrition and physical activity change in primary care: PACE+ for adults.

BACKGROUND: Patient-centered Assessment and Counseling on Exercise plus nutrition (PACE+) is an intervention based in primary care settings to help patients change physical activity and dietary behaviors. METHODS: One hundred seventy-three adults were assessed before and after a 4-month intervention. All patients completed a computerized assessment and created tailored "action plans" to change one physical activity and one nutrition behavior that they then discussed with their provider. After the visit, subjects were randomized to one of four extended intervention conditions: control, mail only, infrequent phone and mail, and frequent phone and mail. Self-report of five target behaviors (moderate and vigorous physical activity stage of change, dietary fat, fruit/vegetable intake, and overeating behaviors) was collected at baseline and 4 months. Acceptability measures were also taken. RESULTS: Participants in all conditions improved on all behaviors over time, supporting the utility of the computer and provider counseling components. The extended intervention did not produce differential results with respect to mode (phone or mail) or intensity (frequent or infrequent). However, for each behavior, participants who targeted the behavior to change improved significantly more than those who did not target the behavior. Acceptability of the intervention was high. CONCLUSIONS: Primary care-based, interactive health communication to improve physical activity and dietary behavior is feasible and has promising initial results.