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1.
Obesity (Silver Spring) ; 28(7): 1235-1244, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32475085

RESUMO

OBJECTIVE: This study aimed to compare two energy-restricted, nutrient-dense diets at the upper or lower ends of the dietary fat recommendation range (lower fat [20% energy from fat] versus moderate fat [35%]) on weight loss using behavioral theory-based nutrition education. METHODS: A total of 101 premenopausal women with overweight or obesity were randomized to an energy-restricted lower-fat or moderate-fat diet for 1 year. Interventions included 28 behavioral theory-based nutrition education sessions plus weekly exercise sessions. RESULTS: Both treatment groups experienced weight loss (-5.0 kg for lower fat and -4.3 kg for moderate fat; P < 0.0001), but there was no difference in weight loss or fat intake between groups. Total and low-density lipoprotein cholesterol decreased (-3. 4 mg/dL and -3.8 mg/dL; P < 0.05), and high-density lipoprotein cholesterol increased (1.9 mg/dL; P < 0.05) in both groups at 12 months. Diet quality, assessed by the Healthy Eating Index, increased significantly at 4 months versus baseline (70.8 [0.9] vs. 77.8 [1.0]) and was maintained through 12 months. Higher Healthy Eating Index scores were associated with greater weight loss at 4 months (r = -0.2; P < 0.05). CONCLUSIONS: In the context of a well-resourced, free-living weight-loss intervention, total fat intake did not change; however, theory-based nutrition education underpinned by food-based recommendations resulted in caloric deficits, improvements in diet quality, and weight loss that was sustained for 1 year.


Assuntos
Manutenção do Peso Corporal/fisiologia , Estilo de Vida , Política Nutricional , Obesidade/dietoterapia , Perda de Peso , Adulto , Restrição Calórica , Dieta com Restrição de Gorduras , Dieta Saudável , Exercício Físico/fisiologia , Feminino , Humanos , Obesidade/terapia
2.
Am J Clin Nutr ; 112(3): 558-565, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32386226

RESUMO

BACKGROUND: The existence of metabolic adaptation, at the level of resting metabolic rate (RMR), remains highly controversial, likely due to lack of standardization of participants' energy balance. Moreover, its role as a driver of relapse remains unproven. OBJECTIVE: The main aim was to determine if metabolic adaptation at the level of RMR was present after weight loss and at 1- and 2-y follow-up, with measurements taken under condition of weight stability. A secondary aim was to investigate race differences in metabolic adaptation after weight loss and if this phenomenon was associated with weight regain. METHODS: A total of 171 overweight women [BMI (kg/m2): 28.3 ± 1.3; age: 35.2 ± 6.3 y; 88 whites and 83 blacks] enrolled in a weight-loss program to achieve a BMI <25, and were followed for 2 y. Body weight and composition (4-compartment model) and RMR (indirect calorimetry) were measured after 4 wk of weight stability at baseline, after weight loss and at 1 and 2 y. Metabolic adaptation was defined as a significantly lower measured compared with predicted RMR (from own regression model). RESULTS: Participants lost, on average, 12 ± 2.6 kg and regained 52% ± 38% and 89% ± 54% of their initial weight lost at 1 and 2 y follow-up, respectively. Metabolic adaptation was found after weight loss (-54 ± 105 kcal/d; P < 0.001), with no difference between races and was positively correlated with fat-mass loss, but not with weight regain, overall. In a subset of women (n = 46) with data at all time points, metabolic adaptation was present after weight loss, but not at 1- or 2-y follow-up (-43 ± 119, P = 0.019; -18 ± 134, P = 0.380; and - 19 ± 166, P = 0.438 kcal/day respectively). CONCLUSIONS: In overweight women, metabolic adaptation at the level of RMR is minimal when measurements are taken under conditions of weight stability and does not predict weight regain up to 2 years follow-up.The JULIET study is registered at https://clinicaltrials.gov/ct2/show/NCT00067873 as NCT00067873.


Assuntos
Adaptação Fisiológica , Manutenção do Peso Corporal/fisiologia , Perda de Peso/fisiologia , Adulto , Metabolismo Basal , Dieta Redutora , Feminino , Humanos , Obesidade/metabolismo , Adulto Jovem
3.
Obesity (Silver Spring) ; 28(7): 1215-1218, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32437055

RESUMO

OBJECTIVE: This study aimed to investigate the roles of frequency and consistency of self-weighing in promoting weight-loss maintenance. METHODS: Participants were 74 adults who completed a 3-month internet-based weight-loss program followed by a 9-month no-intervention maintenance period. Frequency of self-weighing was defined as the number of days that participants self-weighed during the maintenance period via a study-provided smart scale. Consistency was defined as the number of weeks that participants self-weighed at a certain frequency, with multiple minimum thresholds examined. Hierarchical regression analyses were used to assess associations among frequency, consistency, and weight change during the maintenance period. RESULTS: Greater consistency was significantly associated with less weight regain when defined as the number of weeks that participants self-weighed on ≥6 d/wk or 7 d/wk (P values < 0.05). Contrary to hypotheses, frequency was not associated with weight change (P = 0.141), and there was not a significant interaction between frequency and consistency. CONCLUSIONS: Results demonstrate that consistency of self-weighing may be more important than total frequency for preventing weight regain after the end of a weight-loss program. Further, results suggest that a high level of consistency (self-weighing for ≥6 d/wk or 7 d/wk) may be necessary to promote successful weight-loss maintenance.


Assuntos
Manutenção do Peso Corporal/fisiologia , Pesos e Medidas Corporais/métodos , Autoavaliação Diagnóstica , Obesidade/prevenção & controle , Prevenção Secundária/métodos , Perda de Peso , Adulto , Peso Corporal , Pesos e Medidas Corporais/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Obesidade/diagnóstico , Cooperação do Paciente/estatística & dados numéricos , Recidiva , Programas de Redução de Peso/métodos
4.
BMC Public Health ; 20(1): 12, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906895

RESUMO

BACKGROUND: Despite the current obesogenic environment creating challenges weight management, some people succeed in maintaining a normal weight. This study explored lifelong weight management from the life course perspective. We aimed to gain an insight into the issues related to the pathways of individuals of normal weight from childhood to adulthood, and how their experiences and social connections influence their weight management. METHODS: We approached the research topic using qualitative methods. Two age groups (30-45; 55-70 years, men and women), forming a total of 39 individuals, participated in theme interviews. Thematic analysis resulted in two main categories, namely (1) adoption of lifestyle and (2) maintenance of lifestyle. RESULTS: Childhood family played a central role in the formation of lifestyle: food-upbringing created the basis for the interviewees' current diet, and their lives had always been characterized by an active lifestyle. High perceived self-efficacy was vital in weight management. The interviewees were confident about their routines and trusted their abilities to recognize and handle situations that threatened their lifestyles. They possessed skills for adjusting their lifestyle to altered environments, and showed a high level of coping self-efficacy. The interviewees also highlighted the importance of habits for weight management. They had improved their adopted lifestyle through constant learning. New routines had become more internalized through active repetition, finally turning into habitual practices, which simplified weight management. CONCLUSIONS: Based on our interviews, we conclude that childhood was important in the development of the health-promoting lifestyle of our interviewees. However, weight management was described as a journey over the life course, and success also encouraged skills of identifying risks and adjusting actions to cope with challenging situations.


Assuntos
Manutenção do Peso Corporal , Logro , Adaptação Psicológica , Adulto , Idoso , Feminino , Finlândia , Hábitos , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Autoeficácia
5.
Obesity (Silver Spring) ; 28(2): 421-428, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31970912

RESUMO

OBJECTIVE: The study's purpose was to use validated questionnaires to identify novel behavioral and psychological strategies among weight loss maintainers (WLMs) in a commercial weight management program. METHODS: Participants were 4,786 WLMs in WW (formerly Weight Watchers, New York, New York) who had maintained weight loss ≥ 9.1 kg (24.7 kg/23.8% weight loss on average) for 3.3 years and had a current mean BMI of 27.6 kg/m2 . A control group of 528 weight-stable individuals with obesity had a mean BMI of 38.9 kg/m2 and weight change < 2.3 kg over the previous 5 years. RESULTS: WLMs versus Controls practiced more frequent healthy dietary choices (3.3 vs. 1.9; η p 2 = 0.37), self-monitoring (2.6 vs. 0.7; η p 2 = 0.30), and psychological coping (2.5 vs. 1.1; η p 2 = 0.25) strategies. WLMs also reported more willingness to ignore food cravings (4.4 vs. 3.5; η p 2 = 0.16) and had greater habit strength for healthy eating (5.3 vs. 3.2;  η p 2 = 0.21). Standard canonical coefficients indicated that dietary (0.52), self-monitoring (0.40), and psychological (0.14) strategies as well as habit strength for healthy eating (0.15) contributed independently and most (49.5% of variance) to discriminating groups. CONCLUSIONS: In a widely available weight management program, more frequent practice of healthy dietary, self-monitoring, and psychological coping strategies as well as development of greater habit strength for healthy eating differentiated long-term WLMs from weight-stable individuals with obesity.


Assuntos
Manutenção do Peso Corporal/fisiologia , Comportamentos Relacionados com a Saúde , Obesidade/prevenção & controle , Perda de Peso , Programas de Redução de Peso/métodos , Adulto , Dieta , Dieta Saudável/métodos , Dieta Saudável/psicologia , Dieta Saudável/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Motivação/fisiologia , New York/epidemiologia , Obesidade/epidemiologia , Obesidade/psicologia , Psicologia , Autoeficácia , Inquéritos e Questionários , Fatores de Tempo , Volição/fisiologia , Programas de Redução de Peso/estatística & dados numéricos
6.
Obesity (Silver Spring) ; 28(1): 80-88, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31858732

RESUMO

OBJECTIVE: The study objective was to determine whether two self-regulation interventions that reduced 3-year weight gain in young adults remain effective at 6 years. METHODS: A randomized trial was conducted in two academic settings in 599 young adults, aged 18 to 35 years, with normal weight or overweight; 504 (84%) reconsented for a 6-year extension (Study of Novel Approaches to Weight Gain Prevention-Extended [SNAP-E]) with ongoing intervention and assessments. Weight gain over 6 years was compared for all assigned to Control, Large Changes (LC; lose 5-10 pounds initially), and Small Changes (SC; make small daily changes in intake and activity). RESULTS: Weight change from baseline to 6 years did not differ significantly among the three groups (Control = 3.9 kg, SC = 4.1 kg, and LC = 2.8 kg). However, there was a significant age-by-treatment interaction (P = 0.002). Among those < 25 years old, weight gain from baseline to 6 years averaged 7.3 kg in the Control group and was reduced by almost 50% in LC and SC. LC also significantly reduced mean weight gain (area under the curve) over 6 years compared with Control or SC. CONCLUSIONS: Although the interventions did not reduce weight gain at 6 years for the full cohort, they were effective in those < 25 years old. Future efforts should focus on young adults aged 18 to 24.9 and test more intensive interventions with more diverse participants.


Assuntos
Manutenção do Peso Corporal/fisiologia , Trajetória do Peso do Corpo , Obesidade/prevenção & controle , Sobrepeso/prevenção & controle , Programas de Redução de Peso/métodos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Anamnese , Fatores de Tempo , Ganho de Peso/fisiologia , Adulto Jovem
7.
Br J Community Nurs ; 24(12): 576-579, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31800315

RESUMO

Overweight and obesity are known risk factors for the development of lymphoedema, and are also well-recognised factors complicating the management of lymphoedema. However, a degree of uncertainty remains regarding the way in which obesity impacts upon the condition, and there is little detail about the practical application of weight management strategies in the population with lymphoedema. This article provides the background for ongoing research into the association between lymphoedema management and obesity. It is hoped that this research will provide important insights into the long-term management of lymphoedema.


Assuntos
Manutenção do Peso Corporal , Peso Corporal/fisiologia , Linfedema/etiologia , Linfedema/terapia , Obesidade/complicações , Obesidade/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
8.
Z Psychosom Med Psychother ; 65(3): 224-238, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31476994

RESUMO

App-controlled feedback devices can support sustainability of weight loss. Multicentre QUANT-study shows additional weight loss and gain of QoL via multiple feedback-devices in OPTIFAST®52-program Objective: Are three app-controlled feedback devices, tested against a simple pedometer in a weight reduction program, supporting sustainable therapy success and quality of life (QoL)? Methods: In this multi-centre randomised controlled study adults with obesity (n = 89, m = 46.5 years, women n = 54), achieved high weight loss (from 42.7 kg/m² to 35.2 kg/m²) while completing the first three month of the OPTIFAST®52-program. Thereafter the intervention group (IG) used feedback devices (BIA scale, blood pressure monitor, step counter), the control group a mechanical pedometer without app for another year. Intention-to-treat analysis (ITT) and As-treated analysis (AT) were carried out. Results: Feedback devices had a positive effect on fat-loss and secondary study objectives like QoL, leading to a better sustainability of these improvements. Participants in IG (AT for t2-t0) had improvements for Waist-to-Height-ratio (WHtR) and physically and mentally quality of life. Conclusion: The results are presumably based on an increase in self-efficacy and the experience of control. Future studies should be preceded by a pilot study to analyse acceptance problems.


Assuntos
Manutenção do Peso Corporal , Retroalimentação , Aplicativos Móveis , Obesidade/terapia , Qualidade de Vida , Perda de Peso , Programas de Redução de Peso/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
PLoS One ; 14(9): e0222543, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536545

RESUMO

INTRODUCTION: The importance of helping pregnant women maintain a healthy lifestyle and prevent excessive gestational weight gain is well recognized, but pregnant women do not always perceive communication about body weight as respectful or helpful. Furthermore, fear of inducing shame or guilt can prohibit some midwives from talking about body weight, especially if the woman has obesity. We aimed to explore what women of reproductive age with obesity regard to be the most important and relevant aspects when discussing gestational weight management. METHODS: Qualitative interview study using focus groups and individual semi-structured interviews with 17 women of reproductive age (19-39 y) with obesity. Thematic analysis was used to analyze the data. RESULTS: We identified three themes: 1) Importance of obtaining vital medical information; 2) A wish to feel understood and treated with respect; 3) Midwives' approach is crucial in sensitive key situations, which include bringing up the subject of body weight, weighing, providing weight-related information, coaching lifestyle modification, dealing with emotional reactions and ending a conversation. CONCLUSIONS: A majority of the interviewed women wished to receive information about risks about obesity and gestational weight gain, and recommendations on weight management. However, the risk of midwives offending someone by raising the topic may be increased if the pregnant woman believe that gestational weight gain is uncontrollable by the individual. Also, several situations during maternity care meetings can be stigmatizing and make women less receptive to advice or support. Women suggest that a good working alliance is likely to be achieved if midwives have knowledge about the causes of obesity, take interest in the patients' background, have a non-judgmental approach and refrain from giving unsolicited advice.


Assuntos
Manutenção do Peso Corporal/fisiologia , Obesidade/psicologia , Gestantes/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Atitude do Pessoal de Saúde , Índice de Massa Corporal , Comunicação , Feminino , Grupos Focais , Humanos , Estilo de Vida , Serviços de Saúde Materna , Tocologia/métodos , Obesidade/fisiopatologia , Gravidez , Pesquisa Qualitativa , Ganho de Peso/fisiologia , Adulto Jovem
11.
Clin Obes ; 9(5): e12326, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31232524

RESUMO

Our overall objective was to describe the parent-child, romantic, and family dynamics of adult weight management program (WMP) patients, and associations with children's and partners' weight status. First, we determined if family functioning mediated the effect between parent-child feeding practices and perceived child weight status, and romantic relationship anxiety and avoidance and perceived partner weight status. Second, we assessed if perceived child and partner weight status moderated the associations between family functioning and parent-child feeding practices and romantic relationship anxiety and avoidance, respectively. Patients (N=203) who resided with a child and partner from two WMPs completed assessments of parent-child feeding practices (Child Feeding Questionnaire), romantic relationship anxiety and avoidance (Relationship Structures Questionnaire), family functioning (Family Assessment Device General Functioning Scale), and perceived child and partner weight status. Bivariate analyses determined differences in weight status and relationship dynamics and family functioning, and mediation and moderation analyses were conducted to answer the two research questions. Family functioning was not a mediator between romantic relationship dynamics and partner weight status or parent-child dynamics and child weight status. Lower family functioning was associated with higher parent-child restrictive feeding practices, only among children with overweight/obesity. Similarly, lower family functioning was associated with higher anxiety and avoidance in romantic relationships, only for partners with overweight/obesity. Patients with children and/or partners with overweight/obesity reported more impaired family dynamics and functioning, compared to patients with children and/or partners with a healthy weight status.


Assuntos
Peso Corporal , Relações Familiares/psicologia , Programas de Redução de Peso/métodos , Adulto , Estatura , Manutenção do Peso Corporal , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Comportamento Alimentar , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Sobrepeso/psicologia , Relações Pais-Filho , Pais/psicologia , Obesidade Pediátrica/psicologia , Parceiros Sexuais/psicologia , Inquéritos e Questionários
12.
Nutrients ; 11(6)2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31207908

RESUMO

Obesity is associated with microvascular dysfunction. While low-fat diet improves cardiovascular risk, its contributions on microvascular function, independent of weight loss, is unknown. We tested the hypothesis that nitric oxide (NO)-dependent vasodilation in microvessels is improved by low-fat diets designed for weight loss (LFWL) compared to low-fat weight maintenance (LFWM) diet. Obese adults were randomly assigned to either a LFWL diet (n = 11) or LFWM diet (n = 10) for six weeks. Microvessels were obtained from gluteal subcutaneous fat biopsies before and after the intervention for vascular reactivity measurements to acetylcholine (Ach) and flow, with and without L-NAME or indomethacin. Vascular and serum NO and C-reactive protein (CRP) were also measured. LFWL diet increased flow-induced (FID) and ACh-induced dilation (AChID); an effect that was inhibited by L-NAME. Conversely, LFWM diet did not affect FID or AChID. Indomethacin improved FID and AChID in the baseline and this effect was minimized in response to both diets. Serum NO or CRP did not change in response to either diet. In conclusion, LFWL diet improves microvascular reactivity compared to LFWM diet and increased vascular NO contribution to the improved microvascular dilation. These data suggest that weight reduction on low fat diet is critical for microvascular health.


Assuntos
Dieta com Restrição de Gorduras , Óxido Nítrico/metabolismo , Obesidade , Vasodilatação/fisiologia , Perda de Peso/fisiologia , Adolescente , Adulto , Manutenção do Peso Corporal/fisiologia , Feminino , Humanos , Masculino , Microvasos/metabolismo , Microvasos/fisiologia , Pessoa de Meia-Idade , Óxido Nítrico/análise , Obesidade/dietoterapia , Obesidade/fisiopatologia , Gordura Subcutânea/irrigação sanguínea , Adulto Jovem
13.
Obesity (Silver Spring) ; 27(7): 1085-1098, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31135102

RESUMO

OBJECTIVE: The goal of the present study was to deconstruct the 17 treatment arms used in the Early Adult Reduction of weight through LifestYle (EARLY) weight management trials. METHODS: Intervention materials were coded to reflect behavioral domains and behavior change techniques (BCTs) within those domains planned for each treatment arm. The analytical hierarchy process was employed to determine an emphasis profile of domains in each intervention. RESULTS: The intervention arms used BCTs from all of the 16 domains, with an average of 29.3 BCTs per intervention arm. All 12 of the interventions included BCTs from the six domains of Goals and Planning, Feedback and Monitoring, Social Support, Shaping Knowledge, Natural Consequences, and Comparison of Outcomes; 11 of the 12 interventions shared 15 BCTs in common across those six domains. CONCLUSIONS: Weight management interventions are complex. The shared set of BCTs used in the EARLY trials may represent a core intervention that could be studied to determine the required emphases of BCTs and whether additional BCTs add to or detract from efficacy. Deconstructing interventions will aid in reproducibility and understanding of active ingredients.


Assuntos
Terapia Comportamental/métodos , Manutenção do Peso Corporal/fisiologia , Adolescente , Adulto , Feminino , Humanos , Estilo de Vida , Masculino , Adulto Jovem
14.
JMIR Mhealth Uhealth ; 7(5): e12965, 2019 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-31127720

RESUMO

BACKGROUND: Singapore's current prevalence of diabetes exceeds 13.6%. Although lifestyle modification can be effective for reducing the risks for complications of type 2 diabetes mellitus (T2DM), traditional lifestyle interventions are often difficult to administer in the primary care setting due to limited resources. Mobile health apps can address these limitations by offering low-cost, adaptable, and accessible platforms for disseminating lifestyle management interventions. OBJECTIVE: Using the RE-AIM evaluation framework, this study assessed the potential effectiveness and feasibility of GlycoLeap, a mobile lifestyle management program for people with T2DM, as an add-on to standard care. METHODS: This single-arm feasibility study recruited 100 patients with T2DM and glycated hemoglobin (HbA1c) levels of ≥7.5% from a single community health care facility in Singapore. All participants were given access to a 6-month mobile lifestyle management program, GlycoLeap, comprising online lessons and the Glyco mobile phone app with a health coaching feature. The GlycoLeap program was evaluated using 4 relevant dimensions of the RE-AIM framework: (1) reach (percentage who consented to participate out of all patients approached), (2) effectiveness (percentage point change in HbA1c [primary outcome] and weight loss [secondary outcome]), (3) implementation (program engagement as assessed by various participatory metrics), and (4) maintenance (postintervention user satisfaction surveys to predict the sustainability of GlycoLeap). Participants were assessed at baseline and at follow-up (≥12 weeks after starting the intervention). RESULTS: A total of 785 patients were approached of whom 104 consented to participate, placing the reach at 13.2%. Four were excluded after eligibility screening, and 100 patients were recruited. Program engagement (implementation) started out high but decreased with time for all evaluated components. Self-reported survey data suggest that participants monitored their blood glucose on more days in the past week at follow-up compared to baseline (P<.001) and reported positive changes to their diet due to app engagement (P<.001) (implementation). Primary outcome data were available for 83 participants. Statistically significant improvements were observed for HbA1c (-1.3 percentage points, P<.001) with greater improvements for those who logged their weight more often (P=.007) (effectiveness). Participants also had a 2.3% reduction in baseline weight (P<.001) (effectiveness). User satisfaction was high with 74% (59/80) and 79% (63/80) of participants rating the app good or very good and claiming that they would probably or definitely recommend the app to others, respectively (maintenance). CONCLUSIONS: Although measures of program engagement decreased with time, clinically significant improvements in HbA1c were achieved with the potential for broader implementation. However, we cannot rule out that these improvements were due to factors unrelated to GlycoLeap. Therefore, we would recommend evaluating the effectiveness and cost effectiveness of GlycoLeap using a randomized controlled trial of at least 12 months. TRIAL REGISTRATION: ClinicalTrials.gov NCT03091517; https://clinicaltrials.gov/ct2/show/NCT03091517 (Archived by WebCite at http://www.webcitation.org/77rNqhwRn).


Assuntos
Diabetes Mellitus Tipo 2/terapia , Aplicativos Móveis/normas , Comportamento de Redução do Risco , Manutenção do Peso Corporal , Centros Comunitários de Saúde/organização & administração , Centros Comunitários de Saúde/estatística & dados numéricos , Diabetes Mellitus Tipo 2/psicologia , Estudos de Viabilidade , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Tutoria/métodos , Tutoria/normas , Tutoria/estatística & dados numéricos , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Autorrelato , Singapura , Inquéritos e Questionários
15.
Anim Sci J ; 90(7): 870-879, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31099149

RESUMO

Three experiments were carried out to determine the crude protein requirements for maintenance (CPm) and weight gain (CPg) of meat quail and to develop protein-requirement prediction models. Experiment 1 was conducted to determine CPm by the nitrogen-balance technique. The regression of nitrogen balance on nitrogen intake revealed a CPm requirement of 2.94 g/kg0.75 /day. Experiment 2 was aimed at determining CPm by the comparative-slaughter technique. Retained nitrogen (RN) and nitrogen intake (NI) were quantified considering the metabolic weight of the birds. The linear regression of RN on NI provided a CPm estimate of 6.63 g/kg0.75 /day. Experiment 3 was conducted to determine CPg. The regression of body nitrogen from the carcasses on fasted body weight revealed CPg estimates of 407.68 (0-7 days), 501.76 (8-14 days), 470.40 (0-14 days), 517.44 (15-21 days), 627.20 (22-28 days), 423.36 (29-35 days), and 517.44 mg/g (15-35 days). The protein-requirement prediction models developed for meat quail aged 0-7, 8-14, 0-14, 15-21, 22-28, 29-35, and 15-35 days were CP = 2.94.W0.75  + 0.408.G; CP = 2.94.W0.75  + 0.502.G; CP = 2.94.W0.75  + 0.470.G; CP = 2.94.W0.75  + 0,517.G; CP = 2.94.W0.75  + 0.627.G; CP = 2.94.W0.75  + 0.423.G; CP = 2.94.W0.75  + 0.517.G, respectively, where: W0.75  =  metabolic weight (kg), and G =  daily weight gain (g).


Assuntos
Fenômenos Fisiológicos da Nutrição Animal/fisiologia , Dieta/veterinária , Proteínas na Dieta/administração & dosagem , Modelos Estatísticos , Necessidades Nutricionais , Codorniz/fisiologia , Fatores Etários , Ração Animal , Animais , Manutenção do Peso Corporal , Proteínas na Dieta/metabolismo , Nitrogênio/metabolismo , Fatores de Tempo , Ganho de Peso
16.
Am Soc Clin Oncol Educ Book ; 39: e22-e33, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099634

RESUMO

Observational evidence has consistently linked excess adiposity and inactivity to increased breast cancer risk and to poor outcomes in individuals diagnosed with early-stage, potentially curable breast cancer. There is less information from clinical trials testing the effect of weight management or physical activity interventions on breast cancer risk or outcomes, but a number of ongoing trials will test the impact of weight loss and other lifestyle changes after cancer diagnosis on the risk of breast cancer recurrence. Lifestyle changes have additional benefits beyond their potential to decrease primary or secondary breast cancer risk, including improvements in metabolic parameters, reduction in the risk of comorbidities such as diabetes and heart disease, improvement of physical functioning, and mitigation of side effects of cancer therapy. Despite these myriad benefits, implementation of lifestyle interventions in at-risk and survivor populations has been limited to date. This article reviews the evidence linking lifestyle factors to breast cancer risk and outcomes, discusses completed and ongoing randomized trials testing the impact of lifestyle change in primary and secondary breast cancer prevention, and reviews efforts to implement and disseminate lifestyle interventions in at-risk and breast cancer survivor populations.


Assuntos
Manutenção do Peso Corporal , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Exercício Físico , Neoplasias da Mama/etiologia , Ensaios Clínicos como Assunto , Dieta , Detecção Precoce de Câncer , Feminino , Humanos , Estilo de Vida , Obesidade/complicações , Obesidade/epidemiologia , Prevenção Primária , Vigilância em Saúde Pública , Medição de Risco , Prevenção Secundária
17.
Am J Gastroenterol ; 114(9): 1421-1431, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31082868

RESUMO

Intragastric balloons (IGBs) are the most widely available endoscopic bariatric therapy for class I and II obesity in the United States. Although simple in application and reversible by nature, these devices may help patients initiate the important first steps in weight loss maintenance, provided that parallel efforts are in motion to prevent weight recidivism. Too often, therapeutic nihilism stems from unrealistic expectations of a given therapy. In the case of IGBs, this sentiment may occur when these interventions are applied in a vacuum and not within the purview of a multidisciplinary program that actively involves dieticians, endocrinologists, gastroenterologists, and surgeons. There is a clear and present need to apply different tactics in the remissive strategy to control the obesity pandemic, more so in a struggling landscape of an ever-widening gap in bridging interventions. With such demand, the IGB is an available tool that could be helpful when correctly implemented. In this exposition, we summarize the current state of IGBs available worldwide, discuss their mechanism of action, relay evidence for their short- and long-term efficacy, address safety profile concerns, and suggest procedural considerations in the real-world quotidian application.


Assuntos
Cirurgia Bariátrica/métodos , Endoscopia do Sistema Digestório/métodos , Balão Gástrico , Obesidade/cirurgia , Implantação de Prótese/métodos , Manutenção do Peso Corporal , Esvaziamento Gástrico , Grelina/metabolismo , Humanos , Obesidade/metabolismo , Resposta de Saciedade , Resultado do Tratamento , Perda de Peso , Programas de Redução de Peso
18.
Clin Obes ; 9(3): e12309, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30977293

RESUMO

Patient-centred care is an essential component of high-quality health care, shown to improve clinical outcomes and patient satisfaction, and reduce costs. While there are several authoritative models of obesity pathophysiology and treatment algorithms, a truly patient-centred model is lacking. We describe the development of a patient-centric obesity model. A disease-illness framework was selected because it emphasizes each patient's unique experience while capturing biomedical aspects of the disease. Model input was obtained from an accumulation of research including contributions from experts in obesity and patient-reported outcomes, qualitative research with adults living in the United States, and two targeted literature searches. The model places the patient with obesity at its core and links pathologic imbalances of energy intake and expenditure to environmental, sociodemographic, psychological, behavioural, physiological and medical health determinants. It highlights relationships between obesity signs and symptoms, comorbid conditions, impacts on health-related quality of life, and some barriers to obesity management that must be considered to attain better outcomes. Providers need to evaluate patients holistically, understand what changes each patient is motivated to make, and recognize what challenges might impede weight reduction, improvements in comorbid conditions, signs and symptoms, and health-related quality of life before pursuing individualized treatment goals. Patients living with obesity who do lose weight perceive benefits beyond weight loss. Ideally, this model will increase awareness of the complex, heterogeneous impacts of obesity on patients' well-being and recognition of obesity as a chronic disease, and prompt a call to action among stakeholders to improve quality of care.


Assuntos
Obesidade/psicologia , Obesidade/terapia , Assistência Centrada no Paciente/métodos , Manutenção do Peso Corporal , Ingestão de Energia , Humanos , Modelos Teóricos , Obesidade/metabolismo , Obesidade/fisiopatologia , Assistência Centrada no Paciente/economia , Pesquisa Qualitativa , Qualidade de Vida , Estados Unidos , Perda de Peso , Programas de Redução de Peso
20.
JMIR Mhealth Uhealth ; 7(4): e12210, 2019 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-30969174

RESUMO

BACKGROUND: University students are at risk of weight gain during their studies. Key factors related to weight gain in this population include unhealthy weight-related behaviors because of stress. Mindfulness holds promise for weight management. However, there has not been any previous trial that has explored the effectiveness of a student-tailored mindfulness app for stress, weight-related behaviors, and weight. There is limited evidence that current mindfulness apps use evidence-based mindfulness techniques. A novel app was developed that combined evidence-based, mindfulness-based stress reduction and mindful eating (ME) techniques that were tailored to university students, with student-relevant themes for targeting weight behaviors, weight, and stress. OBJECTIVES: The aim of this study was to test the effectiveness, acceptability, and feasibility of a student-tailored mindfulness app for weight, weight-related behaviors, and stress. Testing this app in a rigorous randomized controlled trial (RCT) for these outcomes is a novelty and contribution to this emerging field. METHODS: A 2-arm RCT of an 11-week duration was undertaken at the University of Queensland. Students were either randomized to the mindfulness app (n=45) or to a behavioral self-monitoring electronic diary (e-diary; n=45) for diet and exercise. Analysis of covariance was used to compare differences in weight, stress, mindfulness, ME, physical activity, and eating behaviors between both groups. RESULTS: Neither the mindfulness app group nor the e-diary group lost weight and there were no differences between the groups at follow-up. The mindfulness app group had significantly lower stress levels (P=.02) (adherers only), lower emotional eating (P=.02), and uncontrolled eating (P=.02) as well as higher mindfulness (P≤.001) and ME levels overall (P≤.001). The e-diary group had higher metabolic equivalents of moderate activity levels (P≤.01). However, the effect sizes were small. Regular adherence to mindfulness exercises in the app was low in the group. The majority of students (94%) liked the app and found it to be acceptable. Compared with other exercises, the most helpful reported meditation was the short breathing exercise observing the breath (39.4% [13/33] preferred it). This was the first RCT that tested a mindfulness app for weight and weight-related behaviors in students. The modest level of user adherence likely contributes to the lack of effect on weight loss. However, there was a small, albeit promising, effect on weight-related eating behavior and stress. CONCLUSIONS: A mindfulness app demonstrated effectiveness for stress, eating behaviors, mindfulness, and ME, but the effect sizes were small. Future studies should be conducted over longer periods of time and with greater participant compliance. TRIAL REGISTRATION: Australian New Zealand Trial Registry ACTRN12616001349437; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371370 (Archived by WebCite at http://www.webcitation.org/761cc2K6ft).


Assuntos
Manutenção do Peso Corporal , Atenção Plena , Aplicativos Móveis/normas , Estudantes/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Aplicativos Móveis/estatística & dados numéricos , Queensland , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Estudantes/estatística & dados numéricos , Universidades/organização & administração , Universidades/estatística & dados numéricos
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