Physical Activity and Excess Body Weight and Adiposity for Adults. American College of Sports Medicine Consensus Statement.

ABSTRACT: Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus paper on the role of physical activity in the prevention of weight gain in 2019. This current consensus paper serves as an additional update to those prior ACSM position and consensus papers. The ACSM supports the inclusion of physical activity in medical treatments (pharmacotherapy, metabolic and bariatric surgery) of excess weight and adiposity, as deemed to be medically appropriate, and provides perspectives on physical activity within these therapies. For weight loss and prevention of weight gain, the effects may be most prevalent when physical activity is progressed in an appropriate manner to at least 150 min·wk-1 of moderate-intensity physical activity, and these benefits occur in a dose-response manner. High-intensity interval training does not appear to be superior to moderate-to-vigorous physical activity for body weight regulation, and light-intensity physical activity may also be an alternative approach provided it is of sufficient energy expenditure. Evidence does not support that any one single mode of physical activity is superior to other modes for the prevention of weight gain or weight loss, and to elicit holistic health benefits beyond the effects on body weight and adiposity, multimodal physical activity should be recommended. The interaction between energy expenditure and energy intake is complex, and the effects of exercise on the control of appetite are variable between individuals. Physical activity interventions should be inclusive and tailored for sex, self-identified gender, race, ethnicity, socioeconomic status, age, and developmental level. Intervention approaches can also include different forms, channels, and methods to support physical activity.

Dietary Behaviors, Physical Activity, and Reported Role Models Among Emerging and Young Adults With Overweight and Obesity.

This article characterizes role models identified by emerging/young adults for healthy eating and physical activity (PA), explores variations in reported role models by age, sex and race/ethnicity, and examines dietary/physical activity behaviors in relation to role models. Emerging/young adults (n=397) enrolled in a randomized controlled weight management trial completed assessments at baseline: self-reported role models for healthy eating and PA, Healthy Eating Index, device-measured PA, and demographics. Participants were 78% female, 50% non-White, with mean age 23.3 years, mean BMI 31.1 kg/m2. For both healthy eating and PA, the most frequently reported role model was friend (diet: 35%; PA: 39%). Parent was reported second most frequently for healthy eating (21%) and third most frequently for PA (11%). Role models for healthy eating, but not PA, differed by race/ethnicity. Role models did not differ by age or sex. Results may inform future interventions to promote healthy behaviors in emerging adults.

Physical Activity and Cardiometabolic Risk Factor Clustering in Young Adults with Obesity.

INTRODUCTION: There is a paucity of information on the clustering of cardiometabolic risk factors in young adults and how this clustering may vary based on whether or not they perform sufficient levels of physical activity. METHODS: We analyzed baseline data from 346 young adults (23.3 ± 4.4 yr) participating in the Healthy Body Healthy U clinical trial from 2015 to 2018. Cardiometabolic risk factors were measured according to standard procedures and moderate- to vigorous-intensity physical activity (MVPA) was determined by accelerometry. A cardiometabolic clustering score (ranging from 0 to 5) was created from five biomarkers according to whether or not a standard clinical risk cut point was exceeded (0, no; 1, yes): abdominal circumference (>102 cm (men) or >88 cm (women)), hemoglobin A1c (≥5.7%), HDL cholesterol (<40 mg·dL (men) or <50 mg·dL (women)), systolic blood pressure (≥130 mm Hg), and diastolic blood pressure (≥85 mm Hg). Cardiometabolic dysregulation (CD) was defined as a cardiometabolic clustering score ≥3. Multiple logistic regression determined the independent association between level of MVPA and CD, while adjusting for sex, race/ethnicity, sedentary time, and smoking. RESULTS: The prevalence of CD was 18% (22% in men, 17% in women). We observed a nonlinear graded association between MVPA and CD. Participants performing 150-300 min·wk of MVPA significantly lowered their odds of CD by 66% (odds ratio, 0.34; 95% confidence interval, 0.16-0.75), whereas those exceeding 300 min·wk lowered their odds by 61% (odds ratio, 0.39; 95% confidence interval, 0.18-0.86) compared with those performing <150 min·wk, independent of obesity and the other covariables. CONCLUSION: Recommended levels of moderate-intensity physical activity is significantly associated with lower odds of CD and thus may prevent or diminish the need for expensive pharmaceutical treatment over the remainder of the life-span.

Young adult e-cigarette users: perceptions of stress, body image, and weight control.

OBJECTIVE: With the rise in electronic cigarette (ENDS) use among US young adults, more research is needed on expectations for use and perceptions related to body image, weight control, and stress relief. METHODS: College students (N = 230; modal age 21 years; 68% female) completed an online survey assessing cigarette smoking and ENDS, dieting and body image, perceptions about flavors, stress, weight gain prevention, and appetite regulation. SAMPLE CHARACTERISTICS: Dual use (cigarette and ENDS) was reported by n = 69 (30.0%). Exclusive cigarette smoking was endorsed by n = 53 (23%) with exclusive ENDS use reported by n = 15 (6.5%). Ninety-three participants (40.5%) reported not using either product. RESULTS: Among those using ENDS, < 33% reported using as a stress management tool, < 15% reported using ENDS to control appetite, and > 70% reported using cartridges that tasked like sweets. There was a positive correlation between dieting behaviors and body concern, suggesting those who reported higher use of ENDS for weight and appetite regulation also had higher pathological eating scores and concern over body shape and size. CONCLUSION: Prevention and education related to weight, body image, and tobacco are needed to address misperceptions of tobacco products. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Using social media to deliver weight loss programming to young adults: Design and rationale for the Healthy Body Healthy U (HBHU) trial.

BACKGROUND: The transitional period from late adolescence to early adulthood is a vulnerable period for weight gain, with a twofold increase in overweight/obesity during this life transition. In the United States, approximately one-third of young adults have obesity and are at a high risk for weight gain. PURPOSE: To describe the design and rationale of a National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored randomized, controlled clinical trial, the Healthy Body Healthy U (HBHU) study, which compares the differential efficacy of three interventions on weight loss among young adults aged 18-35years. METHODS: The intervention is delivered via Facebook and SMS Text Messaging (text messaging) and includes: 1) targeted content (Targeted); 2) tailored or personalized feedback (Tailored); or 3) contact control (Control). Recruitment is on-going at two campus sites, with the intervention delivery conducted by the parent site. A total of 450 students will be randomly-assigned to receive one of three programs for 18months. We hypothesize that: a) the Tailored group will lose significantly more weight at the 6, 12, 18month follow-ups compared with the Targeted group; and that b) both the Tailored and Targeted groups will have greater weight loss at the 6, 12, 18month follow-ups than the Control group. We also hypothesize that participants who achieve a 5% weight loss at 6 and 18months will have greater improvements in their cardiometabolic risk factors than those who do not achieve this target. We will examine intervention costs to inform implementation and sustainability other universities. Expected study completion date is 2019. CONCLUSIONS: This project has significant public health impact, as the successful translation could reach as many as 20 million university students each year, and change the current standard of practice for promoting weight management within university campus communities. ClinicalTrial.gov: NCT02342912.

Cost effectiveness of a mail-delivered individually tailored physical activity intervention for Latinas vs. a mailed contact control.

BACKGROUND: Physical inactivity is high in Latinas, as are chronic health conditions. There is a need for physical activity (PA) interventions that are not only effective but have potential for cost-effective widespread dissemination. The purpose of this paper was to assess the costs and cost effectiveness of a Spanish-language print-based mail-delivered PA intervention that was linguistically and culturally adapted for Latinas. METHODS: Adult Latinas (N = 266) were randomly assigned to receive mail-delivered individually tailored intervention materials or wellness information mailed on the same schedule (control). PA was assessed at baseline, six months (post-intervention) and 12 months (maintenance phase) using the 7-Day Physical Activity Recall Interview. Costs were calculated from a payer perspective, and included personnel time (wage, fringe, and overhead), materials, equipment, software, and postage costs. RESULTS: At six months, the PA intervention cost $29/person/month, compared to $15/person/month for wellness control. These costs fell to $17 and $9 at 12 months, respectively. Intervention participants increased their PA by an average of 72 min/week at six months and 94 min/week at 12 months, while wellness control participants increased their PA by an average of 30 min/week and 40 min/week, respectively. At six months, each minute increase in PA cost $0.18 in the intervention group compared to $0.23 in wellness control, which fell to $0.07 and $0.08 at 12 months, respectively. The incremental cost per increase in physical activity associated with the intervention was $0.15 at 6 months and $0.05 at 12 months. CONCLUSIONS: While the intervention was more costly than the wellness control, costs per minute of increase in PA were lower in the intervention. The print-based mail-delivered format has potential for broad, cost-effective dissemination, which could help address disparities in this at-risk population. TRIAL REGISTRATION: NCT01583140; Date of Registration: 03/06/2012; Funding Source of Trial: National Institute of Nursing Research (NINR); Name of Institutional Review Board: Brown University IRB; Date of Approval: 05/19/2009.

The effect of insurance status on pre- and post-operative bariatric surgery outcomes.

BACKGROUND: This study compared pre- and post-surgical data and outcomes among gastric bypass patients based on the type of insurance (Medicaid, Medicare, or private). METHODS: Data were examined from 2553 consecutive RYGB patients at a rural ASMBS Center of Excellence. RESULTS: Participants were primarily female (80.5 %), Caucasian (97.1 %), and middle-aged (45.9 years). Medicaid patients' BMI at consultation was significantly higher than the other two groups (p < 0.001). Time to surgery was significantly longer for Medicaid (13.2 %) and Medicare (7.1 %) patients compared with privately insured patients (p < 0.001). Pre-surgical weight loss and post-surgical percent of excess weight loss nadir did not differ among the groups. Type 2 diabetes remission rates were comparable across insurance groups. CONCLUSIONS: Medicaid patients, although demographically different from their privately insured and Medicare counterparts, will benefit from surgery with comparable weight loss results and overall diabetes remission rates.

Examination of the Beck Depression Inventory-II Factor Structure Among Bariatric Surgery Candidates.

BACKGROUND: The Beck Depression Inventory-II (BDI-II) is frequently used to evaluate bariatric patients in clinical and research settings; yet, there are limited data regarding the factor structure of the BDI-II with a bariatric surgery population. METHODS: Exploratory factor analysis (EFA) using principal axis factoring with oblimin rotation was employed with data from 1228 consecutive presurgical bariatric candidates. Independent t tests were used to examine potential differences between sexes. Confirmatory factor analysis (CFA) was conducted with the next 383 consecutive presurgical patients to evaluate the proposed model based on EFA results. RESULTS: EFA revealed three factors: negative perceptions, diminished vigor, and cognitive dysregulation, each with adequate internal consistency. Six BDI-II items did not load significantly on any of the three factors. CFA results largely supported the proposed model. CONCLUSIONS: Results suggest that dimensions of depression for presurgical bariatric candidates vary from other populations and raise important caveats regarding the utility of the BDI-II in bariatric research.

Internalized weight bias in weight-loss surgery patients: psychosocial correlates and weight loss outcomes.

PURPOSE: In this study, we examined the relationship between pre-operative internalized weight bias and 12-month post-operative weight loss in adult bariatric surgery patients. METHODS: Bariatric surgery patients (n=170) from one urban and one rural medical center completed an internalized weight bias measure (the weight bias internalization scale, WBIS) and a depression survey (Beck depression inventory-II, BDI-II) before surgery, and provided consent to access their medical records. RESULTS: Participants (BMI=47.8 kg/m2, age=45.7 years) were mostly female (82.0 %), White (89.5 %), and underwent gastric bypass (83.6 %). The average WBIS score by item was 4.54 ± 1.3. Higher pre-operative WBIS scores were associated with diminished weight loss at 12 months after surgery (p=0.035). Pre-operative WBIS scores were positively associated with depressive symptoms (p<0.001). CONCLUSION: Greater internalized weight bias was associated with more depressive symptoms before surgery and less weight loss 1 year after surgery.

Smoking and alcohol use in gastric bypass patients.

Bariatric surgery may increase the risk of substance use. The purpose of this study was to prospectively assess smoking and alcohol use before and after bariatric surgery, identify characteristics associated with alcohol use and smoking, and examine substance use and weight loss. Participants (N = 155, mean = 50.1 ± 11.3 y and 45.7 ± 7.0 kg/m(2)) were Roux-en-Y gastric bypass (RYGB) patients that completed surveys on substance use preoperatively and postoperatively. Alcohol use decreased significantly from the preoperative (72.3%) to the postoperative (63.2%) period. As preoperative alcohol quantity rose, the odds of consuming any alcohol postoperatively increased six-fold. Higher BMI increased the odds of high alcohol consumption. Older age decreased the odds of alcohol use and smoking. Smoking status did not differ pre- (19.4%) to post- (14.8%) surgery. Alcohol use and smoking were not associated with weight loss. After weight-loss surgery, alcohol use declined but smoking rates did not significantly change. Younger patients were more likely to use alcohol and smoke postoperatively. Patients with a higher BMI or a history of substance use may be more likely to use alcohol postoperatively.

Determining who responds better to a computer- vs. human-delivered physical activity intervention: results from the community health advice by telephone (CHAT) trial.

BACKGROUND: Little research has explored who responds better to an automated vs. human advisor for health behaviors in general, and for physical activity (PA) promotion in particular. The purpose of this study was to explore baseline factors (i.e., demographics, motivation, interpersonal style, and external resources) that moderate intervention efficacy delivered by either a human or automated advisor. METHODS: Data were from the CHAT Trial, a 12-month randomized controlled trial to increase PA among underactive older adults (full trial N = 218) via a human advisor or automated interactive voice response advisor. Trial results indicated significant increases in PA in both interventions by 12 months that were maintained at 18-months. Regression was used to explore moderation of the two interventions. RESULTS: Results indicated amotivation (i.e., lack of intent in PA) moderated 12-month PA (d = 0.55, p < 0.01) and private self-consciousness (i.e., tendency to attune to one's own inner thoughts and emotions) moderated 18-month PA (d = 0.34, p < 0.05) but a variety of other factors (e.g., demographics) did not (p > 0.12). CONCLUSIONS: Results provide preliminary evidence for generating hypotheses about pathways for supporting later clinical decision-making with regard to the use of either human- vs. computer-delivered interventions for PA promotion.

Differential effects of a body image exposure session on smoking urge between physically active and sedentary female smokers.

Smoking is often used as a maladaptive weight control strategy among female smokers. Many of the perceived benefits accrued from smoking, including enhanced mood, reduced anxiety, and weight control, can also be achieved through physical activity. The purpose of this study was to examine the effects of a novel behavioral task (body-image exposure) that was designed to elicit body image and weight concerns on urge to smoke among 18-24 year old female smokers who vary in levels of physical activity. Using a cue-reactivity paradigm, 16 sedentary (SE) and 21 physically active (PA) female smokers (≥5 cigarettes/day for past 6 months) were exposed to a pilot tested body-image exposure session. Self-reported urge and latency to first puff were obtained before and after exposure session. Paired sample t tests showed significant increases in self-reported urge (p < .01) and quicker latency to first puff (p < .01) at posttest for the entire sample compared with pretest. Results of partial correlation (controlling for body mass index [BMI], nicotine dependence, withdrawal, and depressive symptoms) showed that increased time engaging in vigorous intensity physical activity was associated with lower self-reported urge to smoke at post (r = -0.44; p = .01) but not with latency to first puff (r = -.10; p = .62). These results suggest that among weight-concerned female smokers, physical activity may attenuate smoking urges in a context where weight concerns are increased. Future research should continue to explore effects of physical activity on reactivity to body image and smoking cues and variability in smoking cue-reactivity related to physical activity.

Targeting body image schema for smoking cessation among college females: rationale, program description, and pilot study results.

Smoking among young adults is a significant public health problem. Despite the negative health effects, many young women smoke for weight and body image reasons. Understanding the factors that prompt young women to initiate and continue smoking is important for designing smoking cessation interventions. The aim of the current article is to outline a potential pathway for smoking behavior among young women, specifically applying a cognitive bias framework previously used to describe disordered eating behaviors. This article provides the rationale for using two different treatments targeting body image schema among female smokers. The authors describe the development, feasibility, and acceptability of these two treatment approaches among a sample of female college smokers (N = 24). Preliminary pilot data are presented as well as the significance and implications for future clinical interventions.

Is physical activity a gateway behavior for diet? Findings from a physical activity trial.

OBJECTIVE: While cross-sectional research indicates physical inactivity and poor diet tend to co-occur, there are limited longitudinal data on how interventions targeting one behavior affect other behaviors. The current investigation examined cross-sectional and longitudinal relationships between health behaviors within the context of a physical activity (PA) intervention. METHODS: Sedentary women (n=280; mean age=47.1; 94.6% Caucasian) were enrolled in a randomized controlled PA trial comparing the effects of print-based, individually-tailored and gender-targeted PA interventions to a wellness/control condition. Women completed baseline, month 3, and month 12 assessments that included measures of PA and dietary behaviors. RESULTS: Participants in more advanced PA stages of change reported significantly greater fruits/vegetables consumption than participants in less advanced stages, although the relationships between diet and minutes of weekly activity were less pronounced. The tailored and targeted print-based PA interventions had no effect on fruit/vegetable intake, although significant reductions in fat intake were observed from baseline (M=31.24%) to month 3 (M=30.41%), p<0.03; and baseline to month 12 (M=30.36%), p<0.01. Changes in PA were not predictive of improvements in eating behaviors. CONCLUSIONS: Although fat intake decreased in the context of this PA intervention, fruit/vegetable intake remained unchanged. Also, PA did not serve as a gateway behavior for dietary improvements. In fact, improvements in activity were associated with increases rather than decreases in fat intake.

Commit to Quit in the YMCAs: translating an evidence-based quit smoking program for women into a community setting.

Approximately 22% of women continue to smoke cigarettes despite the increased risk of cancer associated with smoking. Regular aerobic exercise added to our Commit to Quit smoking cessation program for women improved cessation rates compared with the same cessation program plus equal contact time. This trial tested the feasibility of conducting Commit to Quit in the YMCA setting. Among the 77 women who attended informational sessions, 68% (n = 52) were eligible and 56% (N = 43) enrolled in one of five cohorts. All cohorts received the same intervention: the Commit to Quit smoking cessation program, led by Ph.D.-level psychologists, coupled with the YMCA Personal Fitness Program, led by YMCA personal trainers. On quit day in the program 17 women (39.5%) reported a 24-hr quit, and by the end of treatment 3 women (7.0%) reported a 7-day quit. Intent-to-treat analysis (baseline values carried forward) revealed a decrease in the mean number of cigarettes smoked from 9.9 at baseline (SD = 5.0) to 4.8 at the end of treatment (SD = 5.2; t = 4.7; p<.001). Self-reported exercise increased from 530.3 kcal (SD = 587.0) at baseline to 1,256.4 kcal (SD = 1,263.1) at end of treatment (t = -2.489 p = .017). Participants reported high ratings of satisfaction with the smoking cessation program and Personal Fitness Program. Preliminary feasibility and acceptability were demonstrated as we translated an evidence-based intervention into the YMCA setting.