Randomized control trial of a single-session intervention targeting sociocultural pressures of body image in college sorority women.

Objective: To assess the effectiveness of a peer-led single-session intervention targeting the sociocultural pressures of body image. Participants: New members of 13 sororities at one university. Methods: Participants were randomized by sorority into the intervention (n = 207) or wait list control (n = 264). Online surveys were administered at baseline and one month to assess social determinants of body image, body image dissatisfaction (BID), and body appreciation. Multiple logistic and linear regression analyses compared changes over time between groups. Results: We observed significant improvements in overall sociocultural pressures of body image (p = .001) and the subscales of Norms (p < .001) and Perceived Norms (p = .009) of eating and exercise behaviors. Change in BID and body appreciation did not differ between groups. Conclusion: A one-hour peer-led community-level intervention can lead to positive changes in sociocultural pressures in new initiates to a sorority.

Health behavior change benefits: Perspectives of Latinos with serious mental illness.

The objective of this study was to explore the perceived benefits of engaging in health behavior change from the viewpoint of overweight and obese Latinos with severe mental illness (SMI) enrolled in the U.S. Qualitative, semistructured interviews were conducted with 20 obese Latinos with SMI who were enrolled in a randomized trial evaluating the effectiveness of a motivational health promotion intervention adapted for persons with SMI. Overweight and obese Latino participants believed that engaging in health behavior change would have both physical and mental health benefits, including chronic disease management, changes in weight and body composition, and increased self-esteem. Interventions that explicitly link physical activity and healthy eating to improvements in mental health and well-being may motivate Latinos with SMI to adopt health behavior change.

Peer health coaching for overweight and obese individuals with serious mental illness: intervention development and initial feasibility study.

Effective and scalable interventions are needed to reach a greater proportion of individuals with serious mental illness (SMI) who experience alarmingly high rates of obesity. This pilot study evaluated the feasibility of translating an evidenced-based professional health coach model (In SHAPE) to peer health coaching for overweight and obese individuals with SMI. Key stakeholders collaborated to modify In SHAPE to include a transition from professional health coaching to individual and group-based peer health coaching enhanced by mobile health technology. Ten individuals with SMI were recruited from a public mental health agency to participate in a 6-month feasibility pilot study of the new model. There was no overall significant change in mean weight; however, over half (56 %) of participants lost weight by the end of the intervention with mean weight loss 2.7 ± 2.1 kg. Participants reported high satisfaction and perceived benefits from the program. Qualitative interviews with key stakeholders indicated that the intervention was implemented as planned. This formative research showed that peer health coaching for individuals with SMI is feasible. Further research is needed to evaluate its effectiveness.

Normal Weight with Central Obesity, Physical Activity, and Functional Decline: Data from the Osteoarthritis Initiative.

OBJECTIVES: To identify the risks of the combination of normal body mass index (BMI) and central obesity (normal weight and central obesity (NWCO)) on physical activity and function. DESIGN: Longitudinal Osteoarthritis Initiative Study. SETTING: Community based. PARTICIPANTS: Adults aged 60 and older at risk of osteoarthritis (N = 2,210; mean age 68, range 67.1-69.0) were grouped according to BMI (normal 18.5-24.9 kg/m(2) , overweight 25.0-29.9 kg/m(2) , obese ≥30.0 kg/m(2) ). High waist circumference (WC) was defined as greater than 88 cm for women and greater than 102 cm for men. Subjects were subcategorized according to WC (five categories). Subjects with normal BMI and a large WC were considered to have NWCO (n = 280, 12.7%). MEASUREMENTS: Six-year changes in the Physical Component Summary of the Medical Outcomes Study 12-item Short Form Survey (PCS), Physical Activity Scale for the Elderly (PASE), and Late-Life Function and Disability Index (LL-FDI) were examined. The association between BMI and WC over 6 years was assessed (reference normal BMI, normal WC). Stratified analyses were performed according to age (60-69; ≥70). RESULTS: Physical component scores, PASE, and LL-FDI declined with time. Mean PASE scores at 6 years differed between the NWCO group and the group with normal BMI and WC (117.7 vs 141.5), but rate of change from baseline to 6 years was not significantly different (P = .35). In adjusted models, those with NWCO had greater decline in PCS over time, particularly those aged 70 and older than those with normal BMI and WC (time interaction ß = -0.37, 95% confidence interval = -0.68 to -0.06). CONCLUSION: Normal weight and central obesity in older adults at risk of osteoarthritis may be a risk factor for declining function and physical activity, particularly in those aged 70 and older, suggesting the value of targeting those with NWCO who would otherwise be labeled as low risk.

Pragmatic replication trial of health promotion coaching for obesity in serious mental illness and maintenance of outcomes.

OBJECTIVE: Few studies targeting obesity in serious mental illness have reported clinically significant risk reduction, and none have been replicated in community settings or demonstrated sustained outcomes after intervention withdrawal. The authors sought to replicate positive health outcomes demonstrated in a previous randomized effectiveness study of the In SHAPE program across urban community mental health organizations serving an ethnically diverse population. METHOD: Persons with serious mental illness and a body mass index (BMI) >25 receiving services in three community mental health organizations were recruited and randomly assigned either to the 12-month In SHAPE program, which included membership in a public fitness club and weekly meetings with a health promotion coach, or to fitness club membership alone. The primary outcome measures were weight and cardiorespiratory fitness (as measured with the 6-minute walk test), assessed at baseline and at 3, 6, 9, 12, and 18 months. RESULTS: Participants (N=210) were ethnically diverse (46% were nonwhite), with a mean baseline BMI of 36.8 (SD=8.2). At 12 months, the In SHAPE group (N=104) had greater reduction in weight and improved fitness compared with the fitness club membership only group (N=106). Primary outcomes were maintained at 18 months. Approximately half of the In SHAPE group (51% at 12 months and 46% at 18 months) achieved clinically significant cardiovascular risk reduction (a weight loss ≥5% or an increase of >50 meters on the 6-minute walk test). CONCLUSIONS: This is the first replication study confirming the effectiveness of a health coaching intervention in achieving and sustaining clinically significant reductions in cardiovascular risk for overweight and obese persons with serious mental illness.

Feasibility of popular m-health technologies for activity tracking among individuals with serious mental illness.

Obesity prevalence is nearly double among individuals with serious mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder, or major depressive disorder, compared with the general population. Emerging mobile health (m-health) technologies are increasingly available and offer the potential to support lifestyle interventions targeting weight loss, yet the practical feasibility of using these technologies in this high-risk group has not been established. We evaluated the feasibility and acceptability of popular m-health technologies for activity tracking among overweight and obese individuals with SMI. We provided wearable activity monitoring devices (FitBit [San Francisco, CA] Zip™ or Nike Inc. [Beaverton, OR] FuelBand) and smartphones (Apple [Cupertino, CA] iPhone(®) 4S) for accessing the smartphone application for each device to participants with SMI enrolled in a weight loss program. Feasibility of these devices was measured by the frequency of use over time. Acceptability was measured through qualitative follow-up interviews with participants. Ten participants with SMI wore the devices for a mean of 89% (standard deviation=13%) of the days in the study. Five participants wore the devices 100% of the time. Participants reported high satisfaction, stating the devices were easy to use, helpful for setting goals, motivational, and useful for self-monitoring. Several participants liked the social connectivity feature of the devices where they could see each other's progress on the smartphone application, noting that "friendly" competition increased motivation to be more physically active. This study supports using popular m-health technologies for activity tracking among individuals with SMI. These findings can inform the design of weight loss interventions targeting this vulnerable patient population.

The impact of waist circumference on function and physical activity in older adults: longitudinal observational data from the osteoarthritis initiative.

BACKGROUND: We previously demonstrated that BMI is associated with functional decline and reduced quality of life. While BMI in older adults is fraught with challenges, waist circumference (WC) is a marker of visceral adiposity that can also predict mortality. However, its association with function and quality of life in older adults is not well understood and hence we sought to examine the impact of WC on six-year outcomes. METHODS: We identified adults aged ≥60 years from the longitudinal Osteoarthritis Initiative and stratified the cohort into quartiles based on WC. Our primary outcome measures of function at six year follow-up included: self-reported quality of life [Short Form-12 (SF-12)], physical function [Physical Activity Scale for the Elderly (PASE)] and disability [Late-life Disability Index (LLDI)]. Linear regression analyses predicted 6-year outcomes based on WC quartile category (lowest = referent), adjusted for age, sex, race, education, knee pain, smoking status, a modified Charlson co-morbidity index and baseline scores, where available. RESULTS: We identified 2,182 subjects meeting our inclusion criteria and stratified the study cohort by quartiles of WC. Mean age ranged from 67.5-68.7 years, 60-71% were female and 80-86% were white. The highest WC quartile compared to 50-75th, 25-50th or lowest quartile, was associated with a greater number of medications (4.3, 4.0, 3.6 and 3.4 [p < 0.001]), lower gait speeds (1.23, 1.27, 1.32, and 1.34 m/s[p < 0.001]), higher rates of knee osteoarthritis (70.2, 62.2, 60.2, 48.6;p < 0.001), higher Charlson co-morbidity scores and greater knee pain (WOMAC scores) (all p < 0.001). At follow-up, adjusted SF-12 physical function subscale and PASE scores, were lowest in the highest WC quartile as compared to the 50-75%, 25-50%, and lowest quartiles [(SF-12 scores: 45.5, 46.7, 47.6, and 47.9), and (PASE scores: 109.6, 128.7, 126.6, and 131.0). The LLDI limitation subscale for disability demonstrated lower scores in the high WC quartile as opposed to the referent group. CONCLUSIONS: Elevated WC is associated with lower quality of life, a decline in physical function, and a slightly higher risk of disability over time. Intervention studies are needed to prevent functional decline in this high-risk population.

Clinically significant improved fitness and weight loss among overweight persons with serious mental illness.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of a fitness health mentor program (In SHAPE) in improving physical fitness and weight loss among overweight and obese adults with serious mental illness. METHODS: A randomized controlled trial was conducted with 133 persons with serious mental illness and a body mass index (BMI) >25 who were assigned either to the In SHAPE program (one year of weekly sessions with a fitness trainer plus a fitness club membership) or to one year of fitness club membership and education. Assessments were conducted at baseline and three, six, nine, and 12 months later. RESULTS: Participants had a mean baseline weight of 231.8±54.8 pounds and a mean BMI of 37.6±8.2. At 12-month follow-up, In SHAPE (N=67) compared with fitness club membership and education (N=66) was associated with three times greater fitness club attendance, twice as much participation in physical exercise, greater engagement in vigorous physical activity, and improvement in diet. Twice the proportion of participants (40% versus 20%) achieved clinically significant improvement in cardiorespiratory fitness (>50 m on the six-minute walk test). Weight loss and BMI did not differ between groups. Among In SHAPE participants, 49% achieved either clinically significant increased fitness or weight loss (5% or greater), and 24% achieved both clinically significant improved fitness and weight loss. CONCLUSIONS: The In SHAPE program achieved clinically significant reduction in cardiovascular risk for almost one-half of participants at 12 months. Although the intervention showed promise in improving fitness, optimizing weight loss may require additional intensive, multicomponent dietary interventions.

Variation in the prevalence of sarcopenia and sarcopenic obesity in older adults associated with different research definitions: dual-energy X-ray absorptiometry data from the National Health and Nutrition Examination Survey 1999-2004.

OBJECTIVES: To determine the prevalence range for sarcopenic obesity and its relationship with sex, age, and ethnicity. DESIGN: Cross-sectional analysis of a population-based sample. SETTING: Noninstitutionalized persons in the United States participating in the National Health and Nutrition Examination Surveys 1999-2004. PARTICIPANTS: Subsample of 4,984 subjects aged 60 and older with dual-energy X-ray absorptiometry body composition data. MEASUREMENTS: Eight definitions of sarcopenic obesity identified from six studies found using a systematic literature review (Baumgartner, Bouchard, Davison, Zoico, Levine, Kim-1,2,3) were applied to the sample. Results were stratified according to sex, age, and ethnicity. RESULTS: Prevalence of sarcopenic obesity ranged from 4.4% to 84.0% in men and from 3.6% to 94.0% in women. Prevalence was higher in men using definitions from Baumgartner (17.9% vs 13.3%, P < .001), Levine (14.2% vs 6.6%, P < .001), and Kim-1 (30.0% vs 9.3%, P < .001); lower for men using the Davison (4.4% vs 11.1%, P < .001) and Kim-2 (83.7% vs 94.0%) definitions; and the same for men and women using the Bouchard (45.3% vs 44.3%, P = .32) and Kim-3 (75.6% vs 77.0%, P = .51) definitions. For all but one definition, sarcopenic obesity increased with each decade and was lower in non-Hispanic blacks than whites. CONCLUSION: Prevalence of sarcopenic obesity in older adults varies up to 26-fold depending on current research definitions. Such a high degree of variability suggests the need to establish consensus criteria that can be reliably applied across clinical and research settings.

Healthy eating in persons with serious mental illnesses: understanding and barriers.

OBJECTIVE: To explore the understanding of a healthy diet and the barriers to healthy eating in persons with serious mental illnesses. METHODS: In-depth semi-structured qualitative interviews about health behaviors were conducted in 31 individuals with serious mental illnesses. Participants were recruited from a mental health center in Chicago, Illinois, and ranged in age from 30 to 61 years old. RESULTS: Most participants described healthy eating as consuming fruits and vegetables, using low fat cooking methods, and limiting sweets, sodas, fast food, and/or junk food. Internal barriers to nutritional change included negative perceptions of healthy eating, the decreased taste and satiation of healthy foods, difficulty changing familiar eating habits, eating for comfort, and the prioritization of mental health. External barriers were the reduced availability and inconvenience of healthy foods, social pressures, and psychiatric medication side effects. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study revealed several modifiable barriers to healthy eating. Interventions that addressed these could aid in improving the diet and lowering the risk of cardiovascular disease in this population. Recommendations are to provide healthy eating education that is individualized, emphasizes the health consequences of poor eating, and provides opportunities to prepare and taste healthy foods. Family and friends should be included in all educational efforts. At community mental health centers and group homes, only healthy foods should be offered. Lastly, practitioners should encourage eating a healthy diet, inquire about eating in response to emotions, and explore the impact of psychiatric medications on eating behaviors.

Regulation of AMP-activated protein kinase by multisite phosphorylation in response to agents that elevate cellular cAMP.

The AMP-activated protein kinase (AMPK) and cAMP signaling systems are both key regulators of cellular metabolism. In this study, we show that AMPK activity is attenuated in response to cAMP-elevating agents through modulation of at least two of its alpha subunit phosphorylation sites, viz. alpha-Thr(172) and alpha1-Ser(485)/alpha2-Ser(491), in the clonal beta-cell line INS-1 as well as in mouse embryonic fibroblasts and COS cells. Forskolin, isobutylmethylxanthine, and the glucose-dependent insulinotropic peptide inhibited AMPK activity and reduced phosphorylation of the activation loop alpha-Thr(172) via inhibition of calcium/calmodulin-dependent protein kinase kinase-alpha and -beta, but not LKB1. These agents also enhanced phosphorylation of alpha-Ser(485/491) by the cAMP-dependent protein kinase. AMPK alpha-Ser(485/491) phosphorylation was necessary but not sufficient for inhibition of AMPK activity in response to forskolin/isobutylmethylxanthine. We show that AMPK alpha-Ser(485/491) can be a site for autophosphorylation, which may play a role in limiting AMPK activation in response to energy depletion or other regulators. Thus, our findings not only demonstrate cross-talk between the cAMP/cAMP-dependent protein kinase and AMPK signaling modules, but also describe a novel mechanism by which multisite phosphorylation of AMPK contributes to regulation of its enzyme activity.