Supporting Sustainable Health Behavior Change: The Whole is Greater Than the Sum of Its Parts.

Behavior change is the foundation for effective lifestyle prescriptions, yet such change is individualized, nonlinear and typically requires ongoing support. Health and wellness coaching (HWC) is a behavior change intervention with rapidly accruing evidence of positive impact on health behaviors such as exercise, nutrition and stress management. Furthermore, HWC enhances prevention and mitigates exacerbation of chronic lifestyle diseases, at least in the short-term (up to 6 months post intervention). Although the impact on long-term stability of behavior change remains unclear, it is evident that effective partnering with patients using key communication strategies, autonomy promotion, and flexible permissiveness can empower patients to develop healthy lifestyles. This partnership can be cultivated by clinicians as well as clinical team members including nationally board-certified coaches. Although much research is needed regarding the ongoing maintenance of lifestyle changes beyond 6 months, this article seeks to equip clinicians with current evidence, theoretical insights and practical strategies from a "coach approach" to foster more intrinsic forms of motivation which, in turn, empowers patients to adopt and maintain health-promoting behaviors.

Expectations from a Home Cooking Program: Qualitative Analyses of Perceptions from Participants in "Action" and "Contemplation" Stages of Change, before Entering a Bi-Center Randomized Controlled Trial.

Home cooking is an emerging strategy to improve nutrition; however, the literature lacks reports about patient expectations from culinary interventions. Personalized medicine utilizes knowledge about a person's genes; yet, behavioral factors, such as participant "readiness" to make a change, may also impact treatment preferences and outcomes. The purpose is to explore the expectations of participants in different stages of change from a home cooking intervention. Participants were recruited to a randomized controlled trial evaluating the impact of a home cooking intervention on weight. Stage of change assessed by a validated University of Rhode Island Change Assessment scale and expectations through an open-ended questionnaire. Sixteen (21%) participants were in the action stage of change, and 59 (79%) were in the contemplation stage. Participants from both groups shared similar expectations to achieve healthy eating and lifestyle goals and to adopt sustainable change. However, action group expectations also included expanding existing culinary knowledge and change of habits; the contemplation group expectations also included acquiring culinary knowledge, improving self-regulatory skills, and obtaining guidance and support. While action group participants were looking to expand existing knowledge and techniques, contemplation group participants were focusing on acquiring culinary knowledge and skills. This can potentially contribute to developing effective, personalized nutrition interventions.

Physician Assistant Students' Perceptions and Competencies Concerning Lifestyle Medicine.

PURPOSE: With nearly two-thirds of chronic disease attributed to lifestyle, there is a need for physician assistants (PA) to develop competencies in Lifestyle Medicine (LM). The purpose of this study was to assess PA students' skill competencies in exercise and dietary prescription to guide curriculum implementation efforts. METHODS: An online survey was administered to PA students at a single institution. RESULTS: Overall, 74 (63%) students completed the survey, self-reporting moderate competence (range: 1-6) in conducting a physical exam to approve an exercise program (4.17 ± 1.22), designing a nutritional plan (3.76 ± 1.32), and designing an exercise prescription (3.50 ± 1.32). Only about half of the clinical students felt competent in conducting a physical examination to approve an exercise program (56%), determine maximal heart rate (54%), and design a nutritional plan (58%), and only 25% reported competence in designing an exercise prescription. Additionally, 84% of clinical students reported time spent on LM in their program as "poor" or inadequate, and 100% wanted to learn more. CONCLUSIONS: PA students reported inadequate competence and knowledge in LM but expressed an unanimous interest in learning more about LM during their educational training.

Destroying God's Temple? Physical Inactivity, Poor Diet, Obesity, and Other "Sin" Behaviors.

On average, our participants (N = 112), who self-proclaimed to be Christians, believed that physically inactive lifestyles, unhealthy eating, overeating, and being obese destroy the body, God's temple. However, these beliefs were less definitive, than those of other common "sin" behaviors, such as drug use, smoking, and excessive drinking of alcohol. In addition, destroying the body with physical inactivity or poor diet was not necessarily viewed as sinful. Subsequently, these beliefs did not relate to self-reported physical activity, dietary behavior, or body mass index. It is possible that inactivity, poor dietary habits, and obesity are not internalized into the spiritual perspective as destroying the body, God's temple, in the same way as other "sin" behaviors.

Evaluation of Walk Across Texas! - a web-based community physical activity program.

BACKGROUND: In response to the chronic disease burden, web- and community-based programs have the potential to address targeted behaviors, such as physical activity (PA), using a novel approach with large audiences. The purpose of this study was to preliminarily evaluate an established team centered, web-based community PA program in Texas. METHODS: Walk Across Texas! (WAT!) is an eight-week community program delivered through a web-based platform to help people of various ages and abilities establish the habit of regular PA. Teams are challenged to walk a minimum of 832 miles. Changes in self-reported PA (miles/week; days/week) and leisure-time sitting (hours/day) were examined from 11,116 adult participants who participated in the program in 2016. Further analysis determined changes in physical activity (miles/week) between groups of pre-program assessment self-reported physical activity levels (0, 1-2, 3-4, or 5-7 days/week). Statistical analysis included paired-sample t-tests, repeated measures ANOVA and participant descriptors for PA change. RESULTS: Overall, mean changes in PA in all variables were statistically significant (p < .001), with the largest, clinically significant changes in submitted miles/week (mean increase of 4.89 ± 20.92). Self-reported PA increased 0.63 ± 2.89 days/week, while leisure-time sitting decreased less than 1 h per day (0.87 ± 1.86 h/day). All sub-groups (inactive, low active, active, high active at pre-program assessment) increased in self-reported miles per week, on average. Both the inactive and low-active groups experienced a statistically significant increase in mileage from week 1 to week 8 (5.48 miles/week or 12,330 steps /week, and 3.91 miles/week or 8797 steps /week, respectively). CONCLUSIONS: The results provide initial support for the effectiveness of WAT! to initially increase and maintain moderate levels of PA of participants over 8-weeks, even in inactive or low-active participants. Descriptor variables were unable to differentiate between those who increased PA and those who did not. However; the results provide a canvas for future research questions regarding PA enhancement within a team-centered, web-based approach.

A Validation Study of a Noninvasive Lactate Threshold Device.

The lactate threshold is considered a key marker of endurance exercise performance and identification of this threshold is important in writing an exercise training program. Unfortunately, assessment of the lactate threshold has traditionally required venous or capillary blood samples and a specialized meter to assess blood lactate concentrations. Recently, a consumer grade, non-invasive device was developed to determine muscle oxygenation and estimate the lactate threshold. PURPOSE: The aim of this study was to assess the validity of a noninvasive lactate threshold device (NID) to determine lactate threshold heart rate (LTHR). METHODS: Twenty-one recreational athletes (14 females, 39 ± 7 years, 29.1 ± 5.2% fat, 37.8 ± 6.0 ml·kg-1·min-1; 7 males, 42 ± 9 years, 16.8 ± 2.2% fat, 45.9 ± 6.4 ml·kg-1·min-1) completed a personalized graded exercise test on a treadmill. All participants wore the NID and blood lactate samples were taken at the end of 3-minute stages. LTHR was then calculated using two traditional methods (4 mmol/L and >1 mmol/L increase) and compared against the same heart rate values calculated by the NID. RESULTS: No significant differences (p = .87) were found in LTHR between the NID and the traditional lactate methods (NID: 167 ± 9 bpm, 4 mmol/L: 167 ± 12 bpm, >1 mmol/L: 167 ± 12 bpm). CONCLUSIONS: This study provides preliminary support for the validity of the NID for estimation of LTHR.

Beauty and the Body of the Beholder: Raters' BMI Has Only Limited Association with Ratings of Attractiveness of the Opposite Sex.

OBJECTIVE: Assortative mating for adiposity increases the genetic burden on offspring, but its causes remain unclear. One hypothesis is that people who have high adiposity find other people with obesity more physically attractive than lean people. METHODS: The attractiveness of sets of images of males and females who varied in adiposity were rated by opposite sex subjects (559 males and 340 females) across 12 countries. RESULTS: There was tremendous individual variability in attractiveness ratings. For female attractiveness, most males favored the leanest subjects, but others favored intermediate fatness, some were indifferent to body composition, and others rated the subjects with obesity as most attractive. For male images rated by females, the patterns were more complex. Most females favored subjects with low levels of adiposity (but not the lowest level), whereas others were indifferent to body fatness or rated the images depicting individuals with obesity as the most attractive. These patterns were unrelated to rater BMI. Among Caucasian males who rated the images of the thinnest females as being more attractive, the magnitude of the effect depended on rater BMI, indicating limited "mutual attraction." CONCLUSIONS: Individual variations in ratings of physical attractiveness were broadly unrelated to rater BMI and suggest that mutual attraction is an unlikely explanation for assortative mating for obesity.

Medication Adherence, When Lifestyle Is the Medicine.

Giving patients insight, knowledge, and skills, although important, may not alone be enough for behavior change maintenance. Rather, the health care provider (HCP) has an important role in fostering behavior change and maintenance by asking, "Why do people change?" and "What can I do to help?" This review highlights 4 evidence-based factors related to medication adherence, when lifestyle is the medicine. (1) Autonomy is the belief that one is the origin of his or her own actions, and must be supported by the HCP (eg, "My HCP listens to how I would like to do things regarding my health"). (2) Competence and confidence ensure that patients believe they can succeed. These are gained through mastery experience, vicarious experience, and through positive and constructive feedback on past performance (eg, "My HCP conveys confidence in my ability to make changes regarding my health"). (3) Coping planning is being able to formulate a plan of intention, with the awareness of barriers and emotional regulation that can inhibit patient behavior (eg, "I feel able to share my feelings with my HCP"). (4) Personal values of the patients are used to understand how and why they cope when there is a threat to these values (eg, "My HCP tries to understand how I see my health before suggesting any changes").

Why We Don't "Just Do It": Understanding the Intention-Behavior Gap in Lifestyle Medicine.

Intention can be a poor predictor of actual health behavior change-now termed the intention-behavior gap. In other words, although patients intend to change and maintain their behavior, the data suggest that many will not follow through with their intention. This review introduces 5 factors that could help the practitioner understand the patient intention-behavior gap: (1) the motivation, (2) the trigger, (3) the response, (4) the capacity, and (4) the process. These key factors allow the lifestyle medicine practitioner to (1) understand the difficulties in changing patient behavior and (2) apply strategies to encourage successful change and maintenance of healthy lifestyle behavior in their patients.

The relationship of female physical attractiveness to body fatness.

Aspects of the female body may be attractive because they signal evolutionary fitness. Greater body fatness might reflect greater potential to survive famines, but individuals carrying larger fat stores may have poor health and lower fertility in non-famine conditions. A mathematical statistical model using epidemiological data linking fatness to fitness traits, predicted a peaked relationship between fatness and attractiveness (maximum at body mass index (BMI) = 22.8 to 24.8 depending on ethnicity and assumptions). Participants from three Caucasian populations (Austria, Lithuania and the UK), three Asian populations (China, Iran and Mauritius) and four African populations (Kenya, Morocco, Nigeria and Senegal) rated attractiveness of a series of female images varying in fatness (BMI) and waist to hip ratio (WHR). There was an inverse linear relationship between physical attractiveness and body fatness or BMI in all populations. Lower body fat was more attractive, down to at least BMI = 19. There was no peak in the relationship over the range we studied in any population. WHR was a significant independent but less important factor, which was more important (greater r (2)) in African populations. Predictions based on the fitness model were not supported. Raters appeared to use body fat percentage (BF%) and BMI as markers of age. The covariance of BF% and BMI with age indicates that the role of body fatness alone, as a marker of attractiveness, has been overestimated.

Coping with Weight-related Discrepancies: Initial Development of the WEIGHTCOPE.

PURPOSE: The present research sought to provide the initial development, validation and reliability for a measure (WEIGHTCOPE) to assess the variation in how women, who are currently trying to lose or maintain weight, cope with common, perceived weight-related discrepancies. METHODS: To this end, two studies were conducted to 1) develop an initial list of coping responses to common weight-related triggers, 2) create an initial measurement model through exploratory factor analysis (study 1; n = 470), and 3) provide initial validation for the measure through confirmatory factor analysis (study 2; n = 310). FINDINGS: Results support the initial validity and reliability of a 38-item, 10-factor structure: Physical Activity, Healthy Eating, Suppressed Eating, Supplement Use, Self-Regulation, Positive Reframing, Social Support, Disengagement, Camouflage, and Comfort Food. The present findings reiterate individual variation in coping choice in response to a perceived weight-related discrepancy, and its prospective assessment with the WEIGHTCOPE. CONCLUSIONS: The WEIGHTCOPE can be an integral tool for public health and clinical practice, where triggers are common, and interventions are employed to enhance the use of more positive forms of weight control behaviors and/or avoid negative consequences of weight- and fat-related discrepancies. Future research can use the WEIGHTCOPE to help guide theoretical and pragmatic approaches to various triggering events and potential moderators of coping.

Approach, avoidance and weight-related testing: An investigation of frontal EEG asymmetry.

Two motivational systems underlie behaviour and affective responses - an inhibition/avoidance system and an activation/approach system. The purpose of the present study was to explore if individual differences in these motivational systems would occur in response to common weight and body composition testing within a sample of young, adult women. Electroencephalogram was used to distinguish approach or avoidance orientations via frontal asymmetry before and after testing sessions. Clear distinctions in motivational response were found, with 65% of the sample responding with an approach motivation, while 35% responded with an avoidance motivation. Even though all participants, on average, experienced a negative affective response, only the avoidance group self-reported a subsequent increase in "comfort food" consumption of desserts and snacks the week following the testing session. As shown with other stressors, clear individual differences exist in motivational responses to common weight and body composition testing. Such testing produces a general negative affective response; however, the individual differences in motivational responses might produce different behavioural choices. Future research and interventions in health communication should be considerate to this variation in motivational responses to help explain changes in both healthy and unhealthy behaviours following interactions involving one's body weight and/or body composition.