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1.
Obesity (Silver Spring) ; 27(8): 1275-1284, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31338998

RESUMEN

OBJECTIVE: The aim of this study was to characterize weight loss, treatment engagement, and weight control strategies utilized by African American, Hispanic, and non-Hispanic white participants in the Action for Health in Diabetes (Look AHEAD) Intensive Lifestyle Intervention by racial/ethnic and sex subgroups. METHODS: Weight losses at 1, 4, and 8 years among 2,361 adults with obesity and type 2 diabetes randomized to intervention (31% minority; 42% men) are reported by subgroup. Multivariable models within subgroups examine relative contributions of treatment engagement variables and self-reported weight control behaviors. RESULTS: All subgroups averaged weight losses ≥ 5% in year 1 but experienced regain; losses ≥ 5% were sustained at year 8 by non-Hispanic white participants and minority women (but not men). Session attendance was high (≥ 86%) in year 1 and exceeded protocol-specified minimum levels into year 8. Individual session attendance had stronger associations with weight loss among Hispanic and African American participants than non-Hispanic white participants at 4 years (P = 0.04) and 8 years (P = 0.001). Daily self-weighing uptake was considerable in all subgroups and was a prominent factor associated with year 1 weight loss among African American men and women. Greater meal replacement use was strongly associated with poorer 1-year weight losses among African American women. CONCLUSIONS: Experiences of minority men and women with diabetes in lifestyle interventions fill important gaps in the literature that can inform treatment delivery.

2.
Health Promot Pract ; 20(3): 381-389, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-29618233

RESUMEN

BACKGROUND: Wearable physical activity (PA) trackers are becoming increasingly popular for intervention and assessment in health promotion research and practice. The purpose of this article is to present lessons learned from four studies that used commercial PA tracking devices for PA intervention or assessment, present issues encountered with their use, and provide guidelines for determining which tools to use. METHOD: Four case studies are presented that used PA tracking devices (iBitz, Zamzee, FitBit Flex and Zip, Omron Digital Pedometer, Sensewear Armband, and MisFit Flash) in the field-two used the tools for intervention and two used the tools as assessment methods. RESULTS: The four studies presented had varying levels of success with using PA devices and experienced several issues that impacted their studies, such as companies that went out of business, missing data, and lost devices. Percentage ranges for devices that were lost were 0% to 29% and was 0% to 87% for those devices that malfunctioned or lost data. CONCLUSIONS: There is a need for low-cost, easy-to-use, accurate PA tracking devices to use as both intervention and assessment tools in health promotion research related to PA.

3.
Transl Behav Med ; 9(2): 368-372, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-29490082

RESUMEN

Little is known about the impact of the relationship built between interventionists and their participants on weight loss. Our objective is to determine whether stronger early (i.e., 4 weeks) participant-interventionist bond is associated with significantly greater weight loss success and treatment adherence. Three hundred and ninety-eight participants received an online group behavioral weight control program over 18 months. Weight was measured objectively at baseline and at 6 and 18 months. At 4 weeks, participants completed the Working Alliance Inventory (WAI) bonding subscale, which measures the collaborative bond with the interventionist. Adherence (i.e., session attendance and online self-monitoring diary completion) was recorded by the interventionists. Participant-interventionist bond at 4 weeks was significantly associated with weight loss at 6 months (t(322) = -2.14, p = .03) but not at 18 months (t(290) = 0.53, p = .60). The model indicated that participant-interventionist bond at 4 weeks was a significant predictor of adherence at 6 months (b = .063, standard error [SE] = .30, p = .04), and 6 month adherence was a significant predictor of weight loss at 6 months (b = -.594, SE = .049, p < .0001). The indirect effect of the WAI-Bond subscale was significant (b = -.037, p = .03, 95% confidence interval: -.074, -.002) and accounted for 54% of the total effect of participant-interventionist bond on weight loss. However, the total weight loss explained by WAI-Bond subscale was small (0.04 kg). Participant-interventionist bond between participant and interventionist is an early predictor of treatment adherence and weight loss success at 6 months; however, the degree of weight loss explained by participant-interventionist bond is small and was not maintained at 18 months.


Asunto(s)
Obesidad/psicología , Obesidad/terapia , Relaciones Profesional-Paciente , Cumplimiento y Adherencia al Tratamiento/psicología , Pérdida de Peso , Programas de Reducción de Peso , Terapia Conductista , Femenino , Personal de Salud , Humanos , Internet , Masculino , Persona de Mediana Edad , Telemedicina , Terapia Asistida por Computador , Factores de Tiempo , Resultado del Tratamiento
4.
J Urol ; 199(1): 215-222, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28807645

RESUMEN

PURPOSE: We sought to determine whether a behavioral weight reduction intervention would improve nonurinary incontinence lower urinary tract storage symptoms at 6 months, including urinary frequency, nocturia and urgency, compared to a structured education program serving as the control group among overweight and obese women with urinary incontinence. MATERIALS AND METHODS: PRIDE (Program to Reduce Incontinence by Diet and Exercise) was a randomized clinical trial performed in 338 overweight or obese women with urinary incontinence. Participants were randomized, including 226 to 6-month behavioral weight loss intervention and 112 to the control group. All participants received a self-help behavioral treatment booklet to improve bladder control. On this secondary data analysis we examined changes in nonurinary incontinence lower urinary tract storage symptoms from baseline to 6 months and the impact of treatment allocation (intervention vs control), weight loss and physical activity. RESULTS: Nonurinary incontinence lower urinary tract storage symptoms were common at baseline, varying from 48% to 62%. In the 2 groups combined women experienced significant improvement in nocturia, urgency and International Prostate Symptom Score at 6 months (all p <0.001). However, lower urinary tract storage symptom outcomes at 6 months did not differ between the intervention and control groups. Similarly no difference was observed in the amount of weight lost (5% or greater vs less than 5%) or physical activity (1,500 kcal or greater expenditure per week compared to less than 1,500 kcal). CONCLUSIONS: Lower urinary tract storage symptoms were common among overweight and obese women with urinary incontinence. The prevalence decreased significantly after 6 months independent of treatment group assignment, amount of weight lost or physical activity. These improvements may have been due to self-help behavioral educational materials, trial participation or repeat assessment of symptoms.


Asunto(s)
Terapia Conductista/métodos , Sobrepeso/terapia , Incontinencia Urinaria/terapia , Pérdida de Peso/fisiología , Programas de Reducción de Peso/métodos , Adulto , Análisis de Datos , Ejercicio/fisiología , Ejercicio/psicología , Femenino , Humanos , Persona de Mediana Edad , Sobrepeso/fisiopatología , Sobrepeso/psicología , Educación del Paciente como Asunto , Prevalencia , Resultado del Tratamiento , Incontinencia Urinaria/epidemiología , Incontinencia Urinaria/fisiopatología , Incontinencia Urinaria/psicología
5.
JMIR Public Health Surveill ; 3(4): e71, 2017 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-29025698

RESUMEN

BACKGROUND: College freshmen are highly vulnerable to experiencing weight gain, and this phenomenon is associated with an increased risk of chronic diseases and mortality in older adulthood. Technology offers an attractive and scalable way to deliver behavioral weight gain prevention interventions for this population. Weight gain prevention programs that harness the appeal and widespread reach of Web-based technologies (electronic health or eHealth) are increasingly being evaluated in college students. Yet, few of these interventions are informed by college students' perspectives on weight gain prevention and related lifestyle behaviors. OBJECTIVE: The objective of this study was to assess college freshmen students' concern about weight gain and associated topics, as well as their interest in and delivery medium preferences for eHealth programs focused on these topics. METHODS: Web-based surveys that addressed college freshmen students' (convenience sample of N=50) perspectives on weight gain prevention were administered at the beginning and end of the fall 2015 semester as part of a longitudinal investigation of health-related issues and experiences in first semester college freshmen. Data on weight gain prevention-related concerns and corresponding interest in eHealth programs targeting topics of potential concern, as well as preferred program delivery medium and current technology use were gathered and analyzed using descriptive statistics. RESULTS: A considerable proportion of the freshmen sample expressed concern about weight gain (74%, 37/50) and both traditional (healthy diet: 86%, 43/50; physical activity: 64%, 32/50) and less frequently addressed (stress: 82%, 41/50; sleep: 74%, 37/50; anxiety and depression: 60%, 30/50) associated topics within the context of behavioral weight gain prevention. The proportion of students who reported interest in eHealth promotion programs targeting these topics was also generally high (ranging from 52% [26/50] for stress management to 70% [35/50] for eating a healthy diet and staying physically active). Email was the most frequently used electronic platform, with 96% (48/50) of students reporting current use of it. Email was also the most frequently cited preferred eHealth delivery platform, with 86% (43/50) of students selecting it. Facebook was preferred by the second greatest proportion of students (40%, 20/50). CONCLUSIONS: Most college freshmen have concerns about an array of weight gain prevention topics and are generally open to the possibility of receiving eHealth interventions designed to address their concerns, preferably via email compared with popular social media platforms. These preliminary findings offer a foundation to build upon when it comes to future descriptive investigations focused on behavioral weight gain prevention among college freshmen in the digital age.

6.
Am Psychol ; 71(7): 614-627, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27690489

RESUMEN

The majority of individuals with Type 2 diabetes (T2D) are overweight or obese, and this excess adiposity negatively impacts cardiovascular risk and contributes to challenges in disease management. Treatment of obesity by behavioral lifestyle intervention, within the context of diabetes, produces broad and clinically meaningful health improvements, and recent studies demonstrate long-term sustained weight management success with behavioral lifestyle interventions. Details of the Look AHEAD intensive lifestyle intervention are provided as an exemplar approach to the secondary prevention of T2D and obesity. The presence of behavior change expertise in the development and delivery of evidence-based behavioral weight control is discussed, and issues of adaptation and dissemination are raised, with a model to guide these important steps provided. (PsycINFO Database Record


Asunto(s)
Terapia Conductista/métodos , Diabetes Mellitus Tipo 2/prevención & control , Obesidad/prevención & control , Conducta de Reducción del Riesgo , Diabetes Mellitus Tipo 2/etiología , Diabetes Mellitus Tipo 2/psicología , Medicina Basada en la Evidencia , Humanos , Obesidad/complicaciones , Obesidad/psicología
7.
Obesity (Silver Spring) ; 24(11): 2334-2340, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27616628

RESUMEN

OBJECTIVE: To examine whether the addition of online motivational interviewing (MI) chats to a Web-based, group behavioral obesity treatment program augments weight loss outcomes relative to the Web-based weight control program alone. METHODS: Healthy individuals (N = 398, 24% minority) with overweight/obesity were randomized to a 36-session group Internet behavioral weight control treatment (BT) or the same group Internet treatment plus six individual MI chat sessions (BT + MI). Both conditions received weekly synchronous online chat group sessions for 6 months followed by 12 monthly group chats. Participants in both groups received identical behavioral lessons and individualized therapist feedback on progress toward meeting exercise and calorie goals. BT + MI also received six individual MI sessions delivered by a separate MI counselor via Web chat. Weight loss was measured at 6 and 18 months. RESULTS: There were no significant differences in weight loss between BT (-5.5 ± 6.0 kg) and BT + MI (-5.1 ± 6.3 kg) at 6 months or at 18 months (-3.3 ± 7.1 kg vs. -3.5 ± 7.7 kg for BT and BT + MI, respectively). Attendance at group chats did not differ between groups, nor did self-monitoring patterns, suggesting comparable engagement in the weight control program in both conditions. CONCLUSIONS: Online MI chat sessions were not a viable strategy to enhance Web-based weight control treatment outcomes.


Asunto(s)
Internet , Entrevista Motivacional/métodos , Pérdida de Peso , Programas de Reducción de Peso , Adulto , Índice de Masa Corporal , Ingestión de Energía , Medicina Basada en la Evidencia , Ejercicio , Femenino , Conductas Relacionadas con la Salud , Humanos , Estilo de Vida , Modelos Lineales , Masculino , Persona de Mediana Edad , Obesidad/terapia , Factores Socioeconómicos , Resultado del Tratamiento
8.
J Med Internet Res ; 18(6): e133, 2016 06 13.
Artículo en Inglés | MEDLINE | ID: mdl-27296086

RESUMEN

BACKGROUND: Both men and women are vulnerable to weight gain during the college years, and this phenomenon is linked to an increased risk of several chronic diseases and mortality. Technology represents an attractive medium for the delivery of weight control interventions focused on college students, given its reach and appeal among this population. However, few technology-mediated weight gain prevention interventions have been evaluated for college students. OBJECTIVE: This study examined a new technology-based, social media-facilitated weight gain prevention intervention for college students. METHODS: Undergraduates (n =58) in two sections of a public university course were allocated to either a behavioral weight gain prevention intervention (Healthy Weight, HW; N=29) or a human papillomavirus (HPV) vaccination awareness intervention (control; N=29). All students were enrolled, regardless of initial body weight or expressed interest in weight management. The interventions delivered 8 lessons via electronic newsletters and Facebook postings over 9 weeks, which were designed to foster social support and introduce relevant educational content. The HW intervention targeted behavioral strategies to prevent weight gain and provided participants with a Wi-Fi-enabled scale and an electronic physical activity tracker to facilitate weight regulation. A repeated-measures analysis of variance was conducted to examine within- and between-group differences in measures of self-reported weight control practices and objectively measured weight. Use of each intervention medium and device was objectively tracked, and intervention satisfaction measures were obtained. RESULTS: Students remained weight stable (HW: -0.48+1.9 kg; control: -0.45+1.4 kg), with no significant difference between groups over 9 weeks (P =.94). However, HW students reported a significantly greater increase in the number of appropriate weight control strategies than did controls (2.1+4.5 vs -1.1+3.4, respectively; P =.003) and there was no increase in inappropriate weight control behaviors (P =.11). More than 90% of students in the HW arm opened the electronic newsletters each week, and the average number of Facebook interactions (comments and likes) per student each week was 3.3+1.4. Each self-monitoring device was initialized by 90% of HW students. On average, they used their physical activity tracker for 23.7+15.2 days and their Wi-Fi scale for 14.1+13.1 days over the 9 weeks. HW students rated the intervention favorably. CONCLUSIONS: The short-term effect of this technology-based weight gain prevention intervention for college students is promising and merits evaluation over a longer duration to determine whether engagement and behavioral improvements positively affect weight outcomes and can be maintained.


Asunto(s)
Terapia Conductista/métodos , Peso Corporal/fisiología , Obesidad/prevención & control , Medios de Comunicación Sociales , Apoyo Social , Aumento de Peso , Adolescente , Adulto , Ejercicio , Femenino , Humanos , Masculino , Estudiantes , Universidades , Adulto Joven
9.
JMIR Res Protoc ; 5(2): e69, 2016 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-27095604

RESUMEN

BACKGROUND: While Internet-based weight management programs can facilitate access to and engagement in evidence-based lifestyle weight loss programs, the results have generally not been as effective as in-person programs. Furthermore, motivational interviewing (MI) has shown promise as a technique for enhancing weight loss outcomes within face-to-face programs. OBJECTIVE: This paper describes the design, intervention development, and analysis of a therapist-delivered online MI intervention for weight loss in the context of an online weight loss program. METHODS: The MI intervention is delivered within the context of a randomized controlled trial examining the efficacy of an 18-month, group-based, online behavioral weight control program plus individually administered, synchronous online MI sessions relative to the group-based program alone. Six individual 30-minute MI sessions are conducted in private chat rooms over 18 months by doctoral-level psychologists. Sessions use a semistructured interview format for content and session flow and incorporate core MI components (eg, collaborative agenda setting, open-ended questions, reflective listening and summary statements, objective data, and a focus on evoking and amplifying change talk). RESULTS: The project was funded in 2010 and enrollment was completed in 2012. Data analysis is currently under way and the first results are expected in 2016. CONCLUSIONS: This is the first trial to test the efficacy of a synchronous online, one-on-one MI intervention designed to augment an online group behavioral weight loss program. If the addition of MI sessions proves to be successful, this intervention could be disseminated to enhance other distance-based weight loss interventions. TRIAL REGISTRATION: Clinicaltrials.gov NCT01232699; https://clinicaltrials.gov/ct2/show/NCT01232699.

11.
Obesity (Silver Spring) ; 23(7): 1353-6, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-26110890

RESUMEN

OBJECTIVE: Examine the relationship between 1- and 2-month weight loss (WL) and 8-year WL among participants enrolled in a lifestyle intervention. METHODS: 2,290 Look AHEAD participants (BMI: 35.65 ± 5.93 kg/m(2) ) with type 2 diabetes received an intensive behavioral WL intervention. RESULTS: 1- and 2-month WL were associated with yearly WL through Year 8 (P's < 0.0001). At Month 1, participants losing 2-4% and >4% had 1.62 (95% CI: 1.32, 1.98) and 2.79 (95% CI: 2.21, 3.52) times higher odds of achieving ≥5% WL at Year 4 and 1.28 (95% CI: 1.05,1.58) and 1.77 (95% CI: 1.40, 2.24) times higher odds of achieving ≥5% WL at Year 8, compared to those losing <2% initially. At Month 2, 3-6% WL resulted in greater odds of achieving ≥5% WL at Year 4 (OR = 1.85; CI: 1.48, 2.32), and >6% WL resulted in the greatest odds of achieving ≥5% WL at Year 4 (OR = 3.85; CI: 3.05, 4.88) and Year 8 (OR = 2.28; CI: 1.81, 2.89), compared to those losing <3%. Differences in adherence between WL categories were observed as early as Month 2. CONCLUSIONS: 1- and 2-month WL was associated with 8-year WL. Future studies should examine whether alternative treatment strategies can be employed to improve treatment outcomes among those with low initial WL.


Asunto(s)
Terapia Conductista , Diabetes Mellitus Tipo 2/complicaciones , Estilo de Vida , Obesidad/terapia , Pérdida de Peso , Anciano , Peso Corporal , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Resultado del Tratamiento
12.
Obesity (Silver Spring) ; 22(7): 1608-16, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24771618

RESUMEN

OBJECTIVE: Weight losses in lifestyle interventions are variable, yet prediction of long-term success is difficult. The utility of using various weight loss thresholds in the first 2 months of treatment for predicting 1-year outcomes was examined. METHODS: Participants included 2327 adults with type 2 diabetes (BMI:35.8 ± 6.0) randomized to the intensive lifestyle intervention (ILI) of the Look AHEAD trial. ILI included weekly behavioral sessions designed to increase physical activity and reduce caloric intake. 1-month, 2-month, and 1-year weight changes were calculated. RESULTS: Participants failing to achieve a ≥2% weight loss at Month 1 were 5.6 (95% CI:4.5, 7.0) times more likely to also not achieve a ≥10% weight loss at Year 1, compared to those losing ≥2% initially. These odds were increased to 11.6 (95% CI:8.6, 15.6) when using a 3% weight loss threshold at Month 2. Only 15.2% and 8.2% of individuals failing to achieve the ≥2% and ≥3% thresholds at Months 1 and 2, respectively, go on to achieve a ≥10% weight loss at Year 1. CONCLUSIONS: Given the association between initial and 1-year weight loss, the first few months of treatment may be an opportune time to identify those who are unsuccessful and utilize rescue efforts. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00017953.


Asunto(s)
Terapia Conductista/métodos , Diabetes Mellitus Tipo 2/terapia , Estilo de Vida , Obesidad/terapia , Pérdida de Peso , Programas de Reducción de Peso/métodos , Adulto , Anciano , Índice de Masa Corporal , Intervalos de Confianza , Diabetes Mellitus Tipo 2/complicaciones , Ingestión de Energía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Oportunidad Relativa , Educación del Paciente como Asunto/métodos , Resultado del Tratamiento
13.
Res Aging ; 36(1): 22-39, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25651599

RESUMEN

Senior centers are ideal locations to deliver evidence-based health promotion programs to the rapidly growing population of older Americans to help them remain healthy and independent in the community. However, little reported research is conducted in partnership with senior centers; thus, not much is known about barriers and facilitators for senior centers serving as research sites. To fill this gap and potentially accelerate research within senior centers to enhance translation of evidence-based interventions into practice, the present study examined barriers and facilitators of senior centers invited to participate in a cluster-randomized controlled trial. Primary barriers to participation related to staffing and perceived inability to recruit older adult participants meeting research criteria. The primary facilitator was a desire to offer programs that were of interest and beneficial to seniors. Senior centers are interested in participating in research that provides benefit to older adults but may need assistance from researchers to overcome participation barriers.


Asunto(s)
Proyectos de Investigación , Centros para Personas Mayores , Investigación en Medicina Traslacional , Anciano , Anciano de 80 o más Años , Arkansas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto
14.
BMC Public Health ; 13: 586, 2013 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-23773428

RESUMEN

BACKGROUND: Proximity of food stores is associated with dietary intake and obesity; however, individuals frequently shop at stores that are not the most proximal. Little is known about other factors that influence food store choice. The current research describes the development of the Food Store Selection Questionnaire (FSSQ) and describes preliminary results of field testing the questionnaire. METHODS: Development of the FSSQ involved a multidisciplinary literature review, qualitative analysis of focus group transcripts, and expert and community reviews. Field testing consisted of 100 primary household food shoppers (93% female, 64% African American), in rural and urban Arkansas communities, rating FSSQ items as to their importance in store choice and indicating their top two reasons. After eliminating 14 items due to low mean importance scores and high correlations with other items, the final FSSQ questionnaire consists of 49 items. RESULTS: Items rated highest in importance were: meat freshness; store maintenance; store cleanliness; meat varieties; and store safety. Items most commonly rated as top reasons were: low prices; proximity to home; fruit/vegetable freshness; fruit/vegetable variety; and store cleanliness. CONCLUSIONS: The FSSQ is a comprehensive questionnaire for detailing key reasons in food store choice. Although proximity to home was a consideration for participants, there were clearly other key factors in their choice of a food store. Understanding the relative importance of these different dimensions driving food store choice in specific communities may be beneficial in informing policies and programs designed to support healthy dietary intake and obesity prevention.


Asunto(s)
Conducta de Elección , Preferencias Alimentarias , Abastecimiento de Alimentos/normas , Encuestas y Cuestionarios , Adulto , Arkansas , Comportamiento del Consumidor , Dieta/etnología , Dieta/psicología , Ingestión de Energía , Planificación Ambiental , Femenino , Preferencias Alimentarias/etnología , Humanos , Masculino , Persona de Mediana Edad , Obesidad/etnología , Obesidad/prevención & control , Población Rural , Clase Social , Transportes , Población Urbana
15.
Health Educ Behav ; 40(1): 78-87, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22505570

RESUMEN

The relationship between chronic stress and weight management efforts may be a concern for African American (AA) women, who have a high prevalence of obesity, high stress levels, and modest response to obesity treatment. This pilot study randomly assigned 44 overweight/obese AA women with moderate to high stress levels to either a 12-week adaptation of the Diabetes Prevention Program Lifestyle Balance intervention augmented with stress management strategies (Lifestyle + Stress) or Lifestyle Alone. A trend toward greater percentage of baseline weight loss at 3-month data collection was observed in Lifestyle + Stress (-2.7 ± 3.6%) compared with Lifestyle Alone (-1.4 ± 2.3%; p = .17) and a greater reduction in salivary cortisol (Lifestyle + Stress: -0.2461 ± 0.3985 ng/mL; Lifestyle Alone: -0.0002 ± 0.6275 ng/mL; p = .20). These promising results suggest that augmenting a behavioral weight control intervention with stress management components may be beneficial for overweight/obese AA women with moderate to high stress levels and merit further investigation with an adequately powered trial.


Asunto(s)
Afroamericanos/psicología , Estrés Psicológico/terapia , Programas de Reducción de Peso/métodos , Adulto , Femenino , Humanos , Hidrocortisona/análisis , Obesidad/psicología , Obesidad/terapia , Cooperación del Paciente , Proyectos Piloto , Pruebas Psicológicas , Conducta de Reducción del Riesgo , Saliva/química , Pérdida de Peso
16.
Health Psychol ; 32(2): 164-70, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22545978

RESUMEN

OBJECTIVES: Online weight control technologies could reduce barriers to treatment, including increased ease and convenience of self-monitoring. Self-monitoring consistently predicts outcomes in behavioral weight loss programs; however, little is known about patterns of self-monitoring associated with success. METHOD: The current study examines 161 participants (92% women; 31% African American; mean body mass index = 35.7 ± 5.7) randomized to a 6-month online behavioral weight control program that offered weekly group "chat" sessions and online self-monitoring. Self-monitoring log-ins were continuously monitored electronically during treatment and examined in association with weight change and demographics. Weekend and weekday log-ins were examined separately and length of periods of continuous self-monitoring were examined. RESULTS: We found that 91% of participants logged in to the self-monitoring webpage at least once. Over 6 months, these participants monitored on an average of 28% of weekdays and 17% of weekend days, with most log-ins earlier in the program. Women were less likely to log-in, and there were trends for greater self-monitoring by older participants. Race, education, and marital status were not significant predictors of self-monitoring. Both weekday and weekend log-ins were significant independent predictors of weight loss. Patterns of consistent self-monitoring emerged early for participants who went on to achieve greater than a 5% weight loss. CONCLUSIONS: Patterns of online self-monitoring were strongly associated with weight loss outcomes. These results suggest a specific focus on consistent self-monitoring early in a behavioral weight control program might be beneficial for achieving clinically significant weight losses.


Asunto(s)
Terapia Conductista/métodos , Internet , Obesidad/terapia , Autocuidado/métodos , Programas de Reducción de Peso/métodos , Adulto , Anciano , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente/psicología , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Resultado del Tratamiento , Pérdida de Peso , Adulto Joven
17.
J Aging Health ; 25(1): 97-118, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23248351

RESUMEN

OBJECTIVE: To determine whether a cognitive intervention delivered by lay health educators (LHEs) in senior centers was effective in improving cognition in obese older adults. METHODS: This cluster randomized trial was conducted in 16 senior centers from which 228 senior adults were recruited. The centers were randomized to either the cognitive intervention or a control, weight-loss intervention. The primary outcome variable, cognitive function, was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RESULTS: Analyses of RBANS indices as continuous variables did not indicate significant differences between arms. However, after adjusting for baseline delayed memory, gender, and baseline body mass index, seniors in the cognitive intervention arm had a 2.7 times higher odds of a reliable improvement (clinically significant) in delayed memory from baseline as compared to those in the control intervention (95% CI, 1.3-5.6, p = .011). The intervention effect was not significant for the proportion showing reliable improvement in immediate memory or in attention. Attendance at the 12-session program was high with an average of 83% (67%-92%) sessions attended and 87% of participants in the cognitive arm indicating they would recommend the program. DISCUSSION: Cognitive interventions can be effectively delivered in the community by LHEs.


Asunto(s)
Cognición/fisiología , Terapia Cognitivo-Conductual/métodos , Servicios de Salud Comunitaria/organización & administración , Servicios de Salud para Ancianos/organización & administración , Obesidad/terapia , Servicios de Salud Rural/organización & administración , Programas de Reducción de Peso/métodos , Anciano , Arkansas , Análisis por Conglomerados , Práctica Clínica Basada en la Evidencia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pruebas Neuropsicológicas , Evaluación de Programas y Proyectos de Salud
18.
Appetite ; 59(2): 510-6, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22771756

RESUMEN

Previous research indicates food store choice influences dietary intake and may contribute to health disparities. However, there is limited knowledge about the reasons which prompt the choice of a primary food store, particularly among populations vulnerable to obesity and chronic diseases (e.g., individuals living in rural locations and African-Americans). Purposive sampling was used to select rural and urban communities (three African-American and two Caucasian focus groups; n=48) in Arkansas from June to November 2010, allowing examination of potential racial or rurality differences. Primary household food shoppers (n=48) (96% female, 63% African-American, mean age=48.1±13.9years old, mean BMI=30.5±7.8) discussed reasons for choosing their primary store. Qualitative analysis techniques-content analysis and constant comparison-were used to identify themes. Four themes emerged: proximity to home or work, financial considerations and strategies, availability/quality of fruits, vegetables, and meat, and store characteristics (e.g., safety, cleanliness/smell, customer service, non-food merchandise availability, and brand availability). While there were persistent rurality differences, the relevant factors were similar between African-American and Caucasian participants. These findings have important implications for future policies and programs promoting environmental changes related to dietary intake and obesity, particularly in rural areas that appear to have significant challenges in food store choice.


Asunto(s)
Conducta de Elección , Servicios de Alimentación , Adulto , Afroamericanos , Anciano , Animales , Arkansas , Índice de Masa Corporal , Grupo de Ascendencia Continental Europea , Femenino , Grupos Focales , Frutas , Humanos , Masculino , Carne , Persona de Mediana Edad , Investigación Cualitativa , Población Rural , Encuestas y Cuestionarios , Verduras , Adulto Joven
19.
Prev Chronic Dis ; 9: E63, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22360874

RESUMEN

INTRODUCTION: Older adults could benefit from public health interventions that address the health conditions they face. However, translation of evidence-based interventions into the community has been slow. We implemented 2 evidence-based interventions delivered by lay health educators in Arkansas senior centers from 2008 to 2011: a behavioral weight loss intervention and a memory improvement intervention. The objective of this study was to measure the ability of these programs to reach and serve the growing population of older Americans. We report on differences in program enrollment by age, sex, race, and ethnicity and suggest how our approach to calculating the reach of the 2 interventions can guide future research and program development. METHODS: We defined the reach of the 2 interventions as the proportion of people who needed the intervention and responded to initial recruitment efforts but who did not enroll compared with the proportion of people who needed the intervention and actually enrolled in the program. To calculate these proportions, we used Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance framework formulas. We defined need as the prevalence of obesity (body mass index in kg/m2 ≥30) and the level of concern about memory problems among older adults aged 60 years or older. Our target population was 2,198 people aged 60 years or older who attend 15 senior centers in Arkansas. RESULTS: More than half of our target population responded to recruitment efforts for the behavioral weight loss intervention (61.9%) and for the memory improvement intervention (58.1%), yielding an overall response rate of 59.7%. More than one-third (35.6%) of the target population enrolled in the behavioral weight loss intervention, and 22.8% enrolled in the memory improvement intervention, for an overall reach for the 2 programs of 27.9%. CONCLUSION: The reach of 2 evidence-based interventions designed for older adults that targeted specific health conditions and that were delivered in senior centers by community members was high. Our approach to calculating reach in applied settings can guide future research and program development.


Asunto(s)
Medicina Basada en la Evidencia/métodos , Promoción de la Salud , Trastornos de la Memoria/terapia , Pérdida de Peso , Anciano , Anciano de 80 o más Años , Arkansas/epidemiología , Difusión de Innovaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad
20.
Qual Life Res ; 21(10): 1685-94, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22161726

RESUMEN

OBJECTIVE: To estimate the effect of change in weight and change in urinary incontinence (UI) frequency on changes in preference-based measures of health-related quality of life (HRQL) among overweight and obese women with UI participating in a weight loss trial. METHODS: We conducted a longitudinal cohort analysis of 338 overweight and obese women with UI enrolled in a randomized clinical trial comparing a behavioral weight loss intervention to an educational control condition. At baseline, 6, and 18 months, health utilities were estimated using the Health Utilities Index Mark 3 (HUI3), a transformation of the SF-36 to the preference-based SF-6D, and the estimated Quality of Well-Being (eQWB) score (a summary calculated from the SF-36 physical functioning, mental health, bodily pain, general health perceptions, and role limitations-physical subscale scores). Potential predictors of changes in these outcomes were examined using generalized estimating equations. RESULTS: In adjusted multivariable models, weight loss was associated with improvement in HUI3, SF-6D, and eQWB at 6 and 18 months (P < 0.05). Increases in physical activity also were independently associated with improvement in HUI3 (P = 0.01) and SF-6D (P = 0.006) scores at 18 months. In contrast, reduction in UI frequency did not predict improvements in HRQL at 6 or 18 months. CONCLUSION: Weight loss and increased physical activity, but not reduction in UI frequency, were strongly associated with improvements in health utilities measured by the HUI3, SF-6D, and eQWB. These findings provide important information that can be used to inform cost-utility analyses of weight loss interventions.


Asunto(s)
Terapia Conductista/métodos , Obesidad/psicología , Sobrepeso/psicología , Calidad de Vida , Incontinencia Urinaria/psicología , Pérdida de Peso , Adulto , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Persona de Mediana Edad
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