Rural/urban disparities in access to the National Diabetes Prevention Program.

Residents of rural communities generally have limited access to preventive health services such as lifestyle programs for weight management. In 2009, the U.S. Congress authorized the Centers for Disease Control and Prevention (CDC) to partner with local community organizations to disseminate the Diabetes Prevention Program (DPP), an evidence-based lifestyle intervention for weight management. Given that the National DPP (NDPP) was designed to broaden nationwide access to weight-loss treatment for adults at high risk for developing diabetes, the present study examined the implementation of the NDPP in rural and urban counties across the USA. The names and locations of NDPP community partnership sites were collected from the CDC website and cross-referenced with the U.S. Census Bureau's classification of counties as rural versus urban. Results showed that overall 27.9% of the 3,142 counties in the USA contained one or more NDPP partnership sites. However, significantly fewer rural counties had access to a NDPP site compared with urban counties (14.6% vs. 48.4%, respectively, p < .001). This disparity was evident across all types of partnership sites (ps < .001). These findings indicate that implementation of the NDPP has expanded the overall availability of evidence-based weight-management programs across the USA. However, this increase has been disproportionately greater for urban counties versus rural counties, thereby widening the rural/urban disparity in access to preventive health services. Alternative dissemination strategies that address the special barriers to implementation faced by rural communities are needed to increase access to the NDPP.

Effect of dose of behavioral weight loss treatment on glycemic control in adults with prediabetes.

Objective: This study examined the effects of three doses of behavioral weight loss treatment, compared with a nutrition education control group, on changes in glycemic control in individuals with obesity and prediabetes. Research design and methods: The study included 287 adults (77% female, 81% White; mean (SD) age=54.1 (10.5) years, body mass index=36.3 (3.9) kg/m2, and hemoglobin A1c (HbA1c)=5.9 (0.2%)). Participants were randomized to one of three behavioral treatment doses (high=24 sessions, moderate=16 sessions, or low=8 sessions) or to an education group (control=8 sessions). Changes in HbA1c, fasting glucose, and body weight were assessed from baseline to 6 months. Results: Mean (99.2% credible interval (CI)) reductions in HbA1c were 0.11% (0.07% to 0.16%), 0.08% (0.03% to 0.13%), 0.03% (-0.01% to 0.07%), and 0.02% (-0.02% to 0.07%), for the high, moderate, low, and control conditions, respectively. Mean (CI) reductions in fasting blood glucose were 0.26 mmol/L (0.14 to 0.39), 0.09 mmol/L (0 to 0.19), 0.01 mmol/L (-0.07 to 0.09), and 0.04 mmol/L (-0.03 to 0.12) for the high, moderate, low, and control conditions, respectively. The high-dose treatment produced significantly greater reductions in HbA1c and fasting blood glucose than the low-dose and control conditions (posterior probabilities (pp)<0.001); no other significant between-group differences were observed. Mean (CI) reductions in body weight were 10.91 kg (9.30 to 12.64), 10.08 kg (8.38 to 11.72), 6.35 kg (5.19 to 7.69), and 3.82 kg (3.04 to 4.54) for the high, moderate, low, and control conditions, respectively. All between-group differences in 6-month weight change were significant (pps<0.001) except for the high-dose versus moderate-dose comparison. Conclusion: For adults with obesity and prediabetes a high dose of behavioral treatment involving 24 sessions over 6 months may be needed to optimize improvements in glycemic control. Trial registration number: NCT00912652.

Design of the Rural LEAP randomized trial: An evaluation of extended-care programs for weight management delivered via group or individual telephone counseling.

Obesity is a major contributor to the greater prevalence of chronic disease morbidity and mortality observed in rural versus nonrural areas of the U.S. Nonetheless, little research attention has been given to modifying this important driver of rural/urban disparities in health outcomes. Although lifestyle treatments produce weight reductions of sufficient magnitude to improve health, the existing research is limited with respect to the long-term maintenance of treatment effects and the dissemination of services to underserved populations. Recent studies have demonstrated the feasibility of delivering lifestyle programs through the infrastructure of the U.S. Cooperative Extension Service (CES), which has >2900 offices nationwide and whose mission includes nutrition education and health promotion. In addition, several randomized trials have shown that supplementing lifestyle treatment with extended-care programs consisting of either face-to-face sessions or individual telephone counseling can improve the maintenance of weight loss. However, both options entail relatively high costs that inhibit adoption in rural communities. The delivery of extended care via group-based telephone intervention may represent a promising, cost-effective alternative that is well suited to rural residents who tend to be isolated, have heightened concerns about privacy, and report lower quality of life. The Rural Lifestyle Eating and Activity Program (Rural LEAP) is a randomized trial, conducted via CES offices in rural communities, targeted to adults with obesity (n = 528), and designed to evaluate the effectiveness and cost-effectiveness of extended-care programs delivered via group or individual telephone counseling compared to an education control condition on long-term changes in body weight.

What Is the Evidence for "Food Addiction?" A Systematic Review.

The diagnostic construct of "food addiction" is a highly controversial subject. The current systematic review is the first to evaluate empirical studies examining the construct of "food addiction" in humans and animals. Studies were included if they were quantitative, peer-reviewed, and in the English language. The 52 identified studies (35 articles) were qualitatively assessed to determine the extent to which their findings indicated the following addiction characteristics in relation to food: brain reward dysfunction, preoccupation, risky use, impaired control, tolerance/withdrawal, social impairment, chronicity, and relapse. Each pre-defined criterion was supported by at least one study. Brain reward dysfunction and impaired control were supported by the largest number of studies (n = 21 and n = 12, respectively); whereas risky use was supported by the fewest (n = 1). Overall, findings support food addiction as a unique construct consistent with criteria for other substance use disorder diagnoses. The evidence further suggests that certain foods, particularly processed foods with added sweeteners and fats, demonstrate the greatest addictive potential. Though both behavioral and substance-related factors are implicated in the addictive process, symptoms appear to better fit criteria for substance use disorder than behavioral addiction. Future research should explore social/role impairment, preoccupation, and risky use associated with food addiction and evaluate potential interventions for prevention and treatment.