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1.
Rev Med Suisse ; 17(720-1): 59-62, 2021 Jan 13.
Artigo em Francês | MEDLINE | ID: mdl-33443833

RESUMO

The management of obesity comprises lifestyle changes targeting nutrient content, eating behavior and regular physical activity. Medication (orlistat, liraglutide) and bariatric surgery can later be used, but they require a clear indication and a close follow-up. Studies in chronobiology are now exploring the metabolic benefits of intermittent fasting, which restricts food intake and calorie-containing beverages to a certain window of the 24h cycle, or to certain days of the week/month, thus reinstating the alternance between anabolism and catabolism. However, the current scientific evidence is limited by the sample size and duration of the studies. It is therefore too early for a blanket strategy based on intermittent fasting in all patients with metabolic disorders.


Assuntos
Restrição Calórica/métodos , Jejum/fisiologia , Doenças Metabólicas/dietoterapia , Programas de Redução de Peso/métodos , Humanos , Obesidade/dietoterapia , Perda de Peso
2.
JAMA ; 325(4): 363-372, 2021 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-33496775

RESUMO

Importance: Rural populations have a higher prevalence of obesity and poor access to weight loss programs. Effective models for treating obesity in rural clinical practice are needed. Objective: To compare the Medicare Intensive Behavioral Therapy for Obesity fee-for-service model with 2 alternatives: in-clinic group visits based on a patient-centered medical home model and telephone-based group visits based on a disease management model. Design, Setting, and Participants: Cluster randomized trial conducted in 36 primary care practices in the rural Midwestern US. Inclusion criteria included age 20 to 75 years and body mass index of 30 to 45. Participants were enrolled from February 2016 to October 2017. Final follow-up occurred in December 2019. Interventions: All participants received a lifestyle intervention focused on diet, physical activity, and behavior change strategies. In the fee-for-service intervention (n = 473), practice-employed clinicians provided 15-minute in-clinic individual visits at a frequency similar to that reimbursed by Medicare (weekly for 1 month, biweekly for 5 months, and monthly thereafter). In the in-clinic group intervention (n = 468), practice-employed clinicians delivered group visits that were weekly for 3 months, biweekly for 3 months, and monthly thereafter. In the telephone group intervention (n = 466), patients received the same intervention as the in-clinic group intervention, but sessions were delivered remotely via conference calls by centralized staff. Main Outcomes and Measures: The primary outcome was weight change at 24 months. A minimum clinically important difference was defined as 2.75 kg. Results: Among 1407 participants (mean age, 54.7 [SD, 11.8] years; baseline body mass index, 36.7 [SD, 4.0]; 1081 [77%] women), 1220 (87%) completed the trial. Mean weight loss at 24 months was -4.4 kg (95% CI, -5.5 to -3.4 kg) in the in-clinic group intervention, -3.9 kg (95% CI, -5.0 to -2.9 kg) in the telephone group intervention, and -2.6 kg (95% CI, -3.6 to -1.5 kg) in the in-clinic individual intervention. Compared with the in-clinic individual intervention, the mean difference in weight change was -1.9 kg (97.5% CI, -3.5 to -0.2 kg; P = .01) for the in-clinic group intervention and -1.4 kg (97.5% CI, -3.0 to 0.3 kg; P = .06) for the telephone group intervention. Conclusions and Relevance: Among patients with obesity in rural primary care clinics, in-clinic group visits but not telephone-based group visits, compared with in-clinic individual visits, resulted in statistically significantly greater weight loss at 24 months. However, the differences were small in magnitude and of uncertain clinical importance. Trial Registration: ClinicalTrials.gov Identifier: NCT02456636.


Assuntos
Terapia Comportamental , Obesidade/terapia , Psicoterapia de Grupo , Telefone , Programas de Redução de Peso/métodos , Adulto , Idoso , Instituições de Assistência Ambulatorial , Índice de Massa Corporal , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo/métodos , População Rural
3.
JAMA Netw Open ; 3(12): e2027744, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337491

RESUMO

Importance: Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance. Objective: To determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months. Design, Setting, and Participants: In this randomized clinical trial, Latino adults with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 24 or greater and a high risk for type 2 diabetes were recruited in primary care practices in the San Francisco, California, area, randomized to receive the Vida Sana intervention or usual care, and followed up for 24 months. The study was conducted from November 2015 to May 2019, and data were analyzed from July 2019 to Septmeber 2020. Interventions: The treatment group received Vida Sana, a culturally adapted lifestyle intervention that included a family-based orientation session and 22 group sessions over 12 months. Participants were encouraged to use a wearable activity tracker and mobile applications to track their physical activity and dietary intake. Participants received monthly email messages for an additional 12 months. The control group received usual care. Main Outcomes and Measures: The primary outcome was weight loss at 24 months. Secondary outcomes included weight loss at 12 months and achieving at least 5% weight loss at 12 and 24 months. Associations of baseline characteristics and intervention adherence with weight loss outcomes were also examined. Results: Among 191 participants (mean [SD] age, 50.2 [12.2] years; 118 [61.8%] women; 107 participants [57.2%] of Mexican origin; mean [SD] baseline BMI, 32.4 [5.7]) randomized, 92 participants were randomized to the intervention and 99 participants were randomized to usual care. Of these, 185 participants (96.9%) completed 24-month follow-up. Mean (SD) weight loss did not differ significantly by group at 24 months (intervention: -1.1 [5.7] kg; control: -1.1 [7.1] kg; P = .93). However, mean (SD) weight loss was significantly greater in the intervention group (-2.6 [6.0] kg) than the control group (-0.3 [4.2] kg) at 12 months (mean difference, -2.1 [95% CI, -3.6 to -0.7] kg; P = .005). Intervention participants were more likely to achieve at least 5% weight loss than control participants at 12 months (22 participants [25.9%] vs 9 participants [9.2%]; P = .003), and participants who achieved at least 5% weight loss attended more intervention sessions than those who did not (mean [SD], 16.6 [7.6] sessions vs 12.4 [7.5] sessions; P = .03). Conclusions and Relevance: These findings suggest that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months. Trial Registration: ClinicalTrials.gov Identifier: NCT02459691.


Assuntos
Terapia Comportamental/métodos , Assistência à Saúde Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/prevenção & controle , Sobrepeso/terapia , Programas de Redução de Peso/métodos , Adulto , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/etiologia , Feminino , Hispano-Americanos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Sobrepeso/complicações , Sobrepeso/etnologia , São Francisco , Resultado do Tratamento , Perda de Peso
4.
JAMA ; 324(17): 1737-1746, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33141209

RESUMO

Importance: Online programs may help with weight loss but have not been widely implemented in routine primary care. Objective: To compare the effectiveness of a combined intervention, including an online weight management program plus population health management, with the online program only and with usual care. Design, Setting, and Participants: Cluster randomized trial with enrollment from July 19, 2016, through August 10, 2017, at 15 primary care practices in the US. Eligible participants had a scheduled primary care visit and were aged 20 to 70 years, had a body mass index between 27 and less than 40, and had a diagnosis of hypertension or type 2 diabetes. Follow-up ended on May 8, 2019. Interventions: Participants in the usual care group (n = 326) were mailed general information about weight management. Participants in the online program only group (n = 216) and the combined intervention group (n = 298) were registered for the online program. The participants in the combined intervention group also received weight-related population health management, which included additional support from nonclinical staff who monitored their progress in the online program and conducted periodic outreach. Main Outcomes and Measures: The primary outcome was weight change at 12 months based on measured weights recorded in the electronic health record. Weight change at 18 months was a secondary outcome. Results: Among the 840 participants who enrolled (mean age, 59.3 years [SD, 8.6 years]; 60% female; 76.8% White), 732 (87.1%) had a recorded weight at 12 months and the missing weights for the remaining participants were imputed. There was a significant difference in weight change at 12 months by group with a mean weight change of -1.2 kg (95% CI, -2.1 to -0.3 kg) in the usual care group, -1.9 kg (95% CI, -2.6 to -1.1 kg) in the online program only group, and -3.1 kg (95% CI, -3.7 to -2.5 kg) in the combined intervention group (P < .001). The difference in weight change between the combined intervention group and the usual care group was -1.9 kg (97.5% CI, -2.9 to -0.9 kg; P < .001) and the difference between the combined intervention group and the online program only group was -1.2 kg (95% CI, -2.2 to -0.3 kg; P = .01). At 18 months, the mean weight change was -1.9 kg (95% CI, -2.8 to -1.0 kg) in the usual care group, -1.1 kg (95% CI, -2.0 to -0.3 kg) in the online program only group, and -2.8 kg (95% CI, -3.5 to -2.0 kg) in the combined intervention group (P < .001). Conclusions and Relevance: Among primary care patients with overweight or obesity and hypertension or type 2 diabetes, combining population health management with an online program resulted in a small but statistically significant greater weight loss at 12 months compared with usual care or the online program only. Further research is needed to understand the generalizability, scalability, and durability of these findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02656693.


Assuntos
Intervenção Baseada em Internet , Obesidade/terapia , Perda de Peso , Programas de Redução de Peso/métodos , Adulto , Idoso , Índice de Massa Corporal , Terapia Combinada/métodos , Diabetes Mellitus Tipo 2/terapia , Feminino , Humanos , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Sobrepeso/terapia , Satisfação do Paciente , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
5.
Health Psychol ; 39(9): 796-805, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32833481

RESUMO

OBJECTIVES: Weight loss maintenance (WLM) is the next major challenge in obesity treatment. While most individuals who lose weight intend to keep their weight off, weight regain is common. Temporal Self-Regulation Theory posits that whether intentions lead to behavior depends on self-regulatory capacity, including delay discounting (DD; the tendency to discount a larger future reward in favor of a smaller immediate reward). Episodic Future Thinking (EFT; mental imagery of a future event for which a health goal is important) may improve DD and promote behavior change. Described herein is a trial protocol designed to examine whether EFT improves DD within the context of weight loss maintenance. METHOD: Participants who lose ≥5% of initial body weight in an online behavioral weight loss intervention will be randomly assigned to a standard weight loss maintenance program (WLM-STD) or a weight loss maintenance program plus EFT (WLM + EFT). Both interventions involve periodic phone and in-person treatment sessions. Participants in WLM + EFT will engage in daily EFT training via smartphone. To control for contact, participants in WLM-STD will engage in daily Healthy Thinking (reviewing strategies for weight management) on their smartphone. Our primary hypothesis is that WLM + EFT will yield better improvements in DD compared to WLM-STD. We will also explore whether DD mediates the relationship between intervention allocation and physical activity (secondary outcome). Weight and contextual variables will be explored. CONCLUSIONS: This study is the first to test whether EFT improves DD within the context of weight loss maintenance; results from this experimental medicine approach could have important implications for understanding the impact of both EFT and DD on sustained behavior change. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Desvalorização pelo Atraso/fisiologia , Exercício Físico/fisiologia , Memória Episódica , Pensamento/fisiologia , Programas de Redução de Peso/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
6.
PLoS Med ; 17(8): e1003136, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32760144

RESUMO

BACKGROUND: Recent evidence shows that sport settings can act as a powerful draw to engage men in weight loss. The primary objective of this pilot study was to test the feasibility of delivering and to evaluate preliminary efficacy of Aussie-FIT, a weight-loss program for men with overweight/obesity delivered in Australian Football League (AFL) settings, in preparation for a future definitive trial. METHODS AND FINDINGS: This 6-month pilot trial took place in Perth, Australia. Participants were overweight/obese (Body Mass Index [BMI] ≥ 28 kg/m2), middle-aged (35-65 years old) men. Participants were recruited in May 2018, and the intervention took place between June and December 2018. The intervention involved 12 weekly 90-min face-to-face sessions, incorporating physical activity, nutrition, and behaviour change information and practical activities delivered by coaches at 2 clubs. Data were collected at baseline and immediately postintervention. For trial feasibility purposes, 6-month follow-ups were completed. Outcomes were differences in weight loss (primary outcome) and recruitment and retention rates, self-reported measures (for example, psychological well-being), device-measured physical activity, waist size, and blood pressure at 3 months. Within 3 days of advertising at each club, 426 men registered interest; 306 (72%) were eligible. Men were selected on a first-come first-served basis (n = 130; M age = 45.8, SD = 8; M BMI = 34.48 kg/m2, SD = 4.87) and randomised by a blinded researcher. Trial retention was 86% and 63% at 3- and 6-month follow-ups (respectively). No adverse events were reported. At 3 months, mean difference in weight between groups, adjusted for baseline weight and group, was 3.3 kg (95% CI 1.9, 4.8) in favour of the intervention group (p < 0.001). The intervention group's moderate-to-vigorous physical activity (MVPA) was higher than the control group by 8.54 min/day (95% CI 1.37, 15.71, p = 0.02). MVPA among men attracted to Aussie-FIT was high at baseline (intervention arm 35.61 min/day, control arm 38.38 min/day), which may have limited the scope for improvement. CONCLUSIONS: Aussie-FIT was feasible to deliver; participants increased physical activity, decreased weight, and reported improvements in other outcomes. Issues with retention were a limitation of this trial. In a future, fully powered randomised controlled trial (RCT), retention could be improved by conducting assessments outside of holiday seasons. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12617000515392.


Assuntos
Estilo de Vida Saudável/fisiologia , Sobrepeso/terapia , Futebol/fisiologia , Perda de Peso/fisiologia , Programas de Redução de Peso/métodos , Adulto , Idoso , Exercício Físico/fisiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/fisiopatologia , Obesidade/terapia , Sobrepeso/epidemiologia , Sobrepeso/fisiopatologia , Projetos Piloto , Fatores Sexuais , Método Simples-Cego , Austrália Ocidental/epidemiologia
7.
Rev. andal. med. deporte ; 13(2): 92-98, jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194371

RESUMO

OBJECTIVE: To examine the effects of high-intensity interval training on body fat indicators in overweight and obese adults. METHODS: Randomized trials were included in the systematic review. Direct measures (e.g. whole-body fat) and indirect measures (e.g. waist circumference) were examined. RESULTS: From 1156 articles initially screened, 24 were included. The majority of studies were conducted, at least, for 10 weeks. High-intensity interval training elicited reductions in whole- body fat indicators. The meta-analytic models showed significant differences after high-intensity interval training intervention among body weight, fat mass and fat percentage. On the other hand, body mass index and waist circumference did not present significant results. CONCLUSIONS: High-intensity exercise training can induce body composition improvements in overweight and obese individuals. High-intensity interval training may be a time-efficient component of weight management programs


OBJETIVO: Examinar los efectos del entrenamiento en interválico de alta intensidad (HIIT) sobre los indicadores de grasa corporal en adultos con sobrepeso u obesidad. MÉTODOS: Se incluyeron ensayos aleatorios en la revisión sistemática. Se examinaron medidas directas (p. Ej., Grasa corporal total) e indirectas (p. Ej., Circunferencia de la cintura). RESULTADOS: De 1156 artículos encontrados inicialmente, se incluyeron 24. La mayoría de los estudios se realizaron, al menos, durante 10 semanas. El entrenamiento en interválico de alta intensidad provocó reducciones en todos los indicadores de grasa corporal. Los modelos metaanalíticos mostraron diferencias significativas después de la intervención com entrenamiento en interválico de alta intensidad en el peso corporal, la masa grasa y el porcentaje de grasa. Por otro lado, el índice de masa corporal y la circunferencia de la cintura no presentaron cambios significativos. CONCLUSIONES: El entrenamiento físico de alta intensidad puede inducir mejoras en la composición corporal en personas con sobrepeso y obesidad. El entrenamiento en interválico de alta intensidad puede ser un componente tempo-eficiente en los programas de control de peso


OBJETIVO: Examinar os efeitos do treinamento intervalado de alta intensidade (HIIT) nos indicadores de gordura corporal em adultos com sobrepeso ou obesidade. MÉTODOS: Ensaios randomizados foram incluídos na revisão sistemática. Medidas diretas (por exemplo, gordura corporal) e medidas indiretas (por exemplo, circunferência da cintura) foram examinadas. RESULTADOS: Dos 1156 artigos selecionados inicialmente, 24 foram incluídos. A maioria dos estudos foi realizada, pelo menos, por 10 semanas. O treinamento intervalado de alta intensidade provocou reduções nos indicadores de gordura corporal. Os modelos meta-analíticos mostraram diferenças significativas após a intervenção com treinamento intervalado de alta intensidade entre peso corporal, massa gorda e porcentagem de gordura. Por outro lado, o índice de massa corporal e a circunferência da cintura não apresentaram resultados significativos. CONCLUSÕES: O treinamento físico de alta intensidade pode induzir melhorias na composição corporal em indivíduos com sobrepeso e obesidade. O treinamento intervalado de alta intensidade pode ser um componente eficiente em termos de tempo dos programas de controle de peso


Assuntos
Humanos , Masculino , Feminino , Treinamento Intervalado de Alta Intensidade , Programas de Redução de Peso/métodos , Obesidade/fisiopatologia , Circunferência da Cintura , Índice de Massa Corporal , Sobrepeso/metabolismo , Obesidade/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Tecido Adiposo/fisiopatologia
8.
Obesity (Silver Spring) ; 28(6): 1062-1067, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32374527

RESUMO

OBJECTIVE: In traditional behavioral weight loss (BWL) programs, young adults fare worse than older adults with respect to engagement, retention, and weight loss, but money and use of technology have been cited as program factors that might improve outcomes for this population. This study evaluated young adult performance in internet-based BWL (IBWL) offering financial incentives for self-monitoring and weight loss. METHODS: Participants (N = 180; BMI = 33.2 ± 6.0 kg/m2 ) were randomly assigned to a 12-week IBWL or IBWL + incentives (IBWL + $) group. This secondary data analysis compared young adults (ages 18-35) in IBWL (n = 16) with young adults in IBWL + $ (n = 12) on percent weight loss, engagement, and retention. Young adults (n = 28) were also compared with older adults (ages 36-70; n = 152) on these outcomes. RESULTS: Young adult weight loss was -2.8% ± 5.2% in IBWL and -5.4% ± 5.7% in IBWL + $ (P = 0.23, partial η2 = 0.06). A greater proportion of young adults in IBWL + $ achieved a 10% weight loss compared with IBWL (42% vs. 6%, P = 0.02). Compared with older adults, young adults were less engaged, but there were no differences for retention or weight loss (P values > 0.05). CONCLUSIONS: Findings suggest that technology-based BWL has the potential to eliminate weight loss disparities observed between young adults and older adults in in-person BWL trials. Moreover, adding financial incentives holds promise for promoting clinically meaningful weight loss for young adults.


Assuntos
Obesidade/terapia , Reembolso de Incentivo/normas , Perda de Peso/fisiologia , Programas de Redução de Peso/economia , Adolescente , Adulto , Idoso , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Motivação , Programas de Redução de Peso/métodos , Adulto Jovem
9.
BMC Public Health ; 20(1): 652, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393214

RESUMO

BACKGROUND: Given the current worldwide epidemic of obesity, there is a demand for interventions with higher impact, such as those carried out in the primary health care (PHC) setting. Here we evaluate the effect of intervention performed according to the stages of change of the transtheoretical model (TTM) for weight management. METHODS: This randomized controlled trial in Brazilian PHC offered free physical exercise and nutrition education. The participants were women, aged 20 years or older who were obese or overweight, users in PHC service. The intervention group (IG, n = 51) received the same orientation as the comparison group (CG, n = 35) plus individual health counseling based on the TTM aimed at weight loss, which lasted 6 months. The outcome measures were anthropometric, food, and nutrient profiles. Inflammatory parameters were evaluated in a random subsample. The inter-group and intra-group differences were evaluated using interntion-to-treat analysis, and analysis of covariance (ANCOVA) used to assess intervention effectiveness. RESULTS: There was a difference between groups of - 1.4 kg (CI95%: - 2.5; - 0.3) in body weight after the intervention. About 97% of women in the IG reported benefits of the intervention and presented positive changes in diet, biochemical markers, and anthropometry. The IG showed better body mass index, resistine, and blood glucose results compared to the CG during follow-up. CONCLUSION: The individualized TTM-based intervention, combined with usual care, was an effective strategy in PHC. These results should encourage the use of interdisciplinary practices; nevertheless, research to identify additional strategies is needed to address barriers to weight maintenance among obese low-income women. TRIAL REGISTRATION: The trial is registered with Brazilian clinical trials under the code: RBR-8t7ssv, Registration date: 12/12/2017 (retrospectively registered).


Assuntos
Ciências Biocomportamentais/métodos , Obesidade/terapia , Sobrepeso/terapia , Programas de Redução de Peso/métodos , Adulto , Idoso , Índice de Massa Corporal , Brasil , Dieta , Exercício Físico , Terapia por Exercício/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/psicologia , Sobrepeso/psicologia , Educação de Pacientes como Assunto/métodos , Pobreza , Atenção Primária à Saúde , Resultado do Tratamento , Perda de Peso , Adulto Jovem
10.
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
11.
Med Sci (Paris) ; 36(5): 472-478, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32452369

RESUMO

Substantial reviews of the most recent evidence report a strong relationship between the consumption of sugar-sweetened beverages and adverse health effects, such as the prevalence of obesity and metabolic diseases. Various public policies were recently undertaken by many countries in the hope of reducing sugar-sweetened beverage consumption amongst their population. This has led the food industries to promote low-calorie sweeteners (sugar substitutes) as a healthy alternative that would limit caloric intake without compromising the sweet taste of food and beverages. However, is the use of low-calorie sweeteners as a means of limiting or reducing energy intake without consequences for our health? This review aims to discuss the effects of low-calorie sweeteners consumption on health and to elucidate whether their use should be recommended by health professionals to their patients as part of weight management.


Assuntos
Bebidas , Ingestão de Energia/fisiologia , Edulcorantes/efeitos adversos , Edulcorantes/farmacologia , Bebidas/efeitos adversos , Restrição Calórica/efeitos adversos , Dieta com Restrição de Carboidratos/efeitos adversos , Humanos , Obesidade/terapia , Programas de Redução de Peso/métodos
12.
BMC Med ; 18(1): 86, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32295605

RESUMO

BACKGROUND: Trials have shown total diet replacement (TDR) programmes are safe and effective for weight loss in primary care. However, it is not clear whether participant characteristics affect uptake, attendance, or effectiveness of the programme. METHODS: We used data from 272 trial participants who were invited to participate in a clinical weight loss trial via a letter from their GP. We used a Cochran-Mantel-Haenszel analysis to assess whether accepting an invitation to participate in the trial differed by gender, age, BMI, social deprivation, and the presence of a diagnosis of type 2 diabetes or hypertension. We used mixed generalised linear modelling to examine whether participants' age, gender, or social deprivation based on area of residence were associated with weight change at 12 months. RESULTS: Men were less likely to enrol than women (RR 0.59 [95% CI 0.47, 0.74]), and people from the middle and highest BMI tertile were more likely to enrol than those from the lowest tertile (RR 2.88 [95% CI 1.97, 4.22] and RR 4.38 [95% CI 3.05, 6.07], respectively). Patients from practices located in most deprived and intermediate deprived tertiles were more likely to enrol compared with those in the least deprived tertile (RR 1.84 [95% CI 1.81, 2.59] and RR 1.68 [95% CI 1.18, 2.85], respectively). There was no evidence that age or a pre-existing diagnosis of type 2 diabetes (RR 1.10 [95% CI 0.81, 1.50]) or hypertension (RR 0.81 [95% CI 0.62, 1.04]) affected enrolment. In the TDR group, 13% of participants were low engagers, 8% engaged with the weight loss phase only, and 79% engaged in both weight loss and weight maintenance phases of the programme. Those who engaged in the entire programme lost most weight. Subgroup analyses suggested that older participants and those with a higher baseline BMI lost more weight at 1 year than their comparators. CONCLUSION: Despite some heterogeneity in the uptake and outcomes of the programme, if the results of this trial are replicated in routine practice, there is no evidence that TDR weight loss programmes would increase inequity. TRIAL REGISTRATION: The DROPLET trial was prospectively registered on ISRCTN registry (ISRCTN75092026).


Assuntos
Dieta Redutora/métodos , Programas de Redução de Peso/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Obes Facts ; 13(2): 256-266, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32268328

RESUMO

INTRODUCTION: Maternal obesity and excessive gestational weight gain are related to adverse outcomes in women and children. Lifestyle interventions during pregnancy showed positive effects on decreasing weight gain during pregnancy, but effects on offspring's health and wellbeing are unclear. We aimed to assess the effect of lifestyle intervention programmes on offspring mental health, temperament, eating habits and anthropometric and cardiovascular measures. METHODS: Ninety-six offspring of pregnant women with a body mass index (BMI) ≥29 kg/m2 who were randomly assigned to 3 intervention groups during pregnancy (routine antenatal care, a brochure group or a prenatal session group) and 77 offspring of pregnant women with a normal BMI (between 18.5 and 24.9 kg/m2) were used as an additional control group in this analysis. When the children were between 3 and 7 years old, anthropometric and cardiovascular measurements were conducted and various questionnaires about offspring mental health, temperament and eating habits were filled out. RESULTS: Children of mothers who received a brochure-based lifestyle intervention programme showed significantly less surgency/extraversion compared to children of mothers who received routine antenatal care (contrast estimate = -0.36, SE = 0.15, p = 0.02, 95% CI [-6.66, -0.06]) and prenatal lifestyle intervention sessions (contrast estimate = -0.46, SE = 0.14, p < 0.01, 95% CI [-0.74, -0.18]) after adjusting for child's age, sex, offspring birth weight and mother's educational level. The lifestyle intervention could not be associated with any significant differences in offspring mental health, eating habits and anthropometric and cardiovascular characteristics. Children of mothers with a normal BMI showed less emotional problems (F(1, 156) = 5.42, p = 0.02) and internalizing (F(1, 156) = 3.04, p = 0.08) and externalizing problems (F(1, 156) = 6.10, p = 0.02) when compared to children of mothers in the obese group. DISCUSSION/CONCLUSION: The results suggest that a brochure-based lifestyle intervention programme can affect the offspring temperament. Future follow-up studies need to investigate how these temperament-related effects may influence obesity development later in life.


Assuntos
Pesos e Medidas Corporais/estatística & dados numéricos , Desenvolvimento Infantil/fisiologia , Cognição/fisiologia , Estilo de Vida , Obesidade/terapia , Complicações na Gravidez/terapia , Cuidado Pré-Natal/métodos , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Seguimentos , Ganho de Peso na Gestação/fisiologia , Humanos , Masculino , Mães/estatística & dados numéricos , Obesidade/complicações , Obesidade/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Fatores de Risco , Comportamento de Redução do Risco , Programas de Redução de Peso/métodos , Adulto Jovem
14.
Nutr. hosp ; 37(2): 275-284, mar.-abr. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190591

RESUMO

INTRODUCCIÓN Y OBJETIVOS: la obesidad y el sobrepeso constituyen uno de los principales problemas de salud pública en el mundo. De ahí la importancia de desarrollar y aplicar estrategias que logren disminuir el peso en esta población. Por ello nos propusimos como objetivo evaluar la efectividad de la intervención en la obesidad con tres enfoques diferentes, uno de ellos con una plataforma que promueve la actividad física. MATERIAL Y MÉTODOS: ensayo clínico multicéntrico, aleatorizado, controlado y de grupos paralelos que comparó 3 brazos de pacientes con sobrepeso u obesidad con un seguimiento de 12 meses. Los pacientes se asignaron al azar a tres grupos de intervención en un centro de Atención Primaria: G1: grupo de control que recibió las recomendaciones habituales para perder peso siguiendo el Consenso SEEDO 2000; G2: intervención motivacional de la obesidad (IMOAP) con enfermera entrenada y pequeños grupos de trabajo periódico; G3: intervención motivacional de la obesidad (IMOAP) añadiendo el uso de una plataforma digital que permite registrar la actividad física, la monitoriza y favorece la práctica de esta (IWOPI). Se recolectaron las variables: peso, talla, IMC, circunferencia de la cintura, parámetros lipídicos, presión arterial y hemoglobina glucosilada. Después de realizar las intervenciones se estudiaron los indicadores de relevancia clínica: riesgo relativo (RR), reducción del riesgo absoluto (ARR), reducción del riesgo relativo (RRR) y número necesario de pacientes a tratar (NNT), tanto por intención de tratar como por eficacia biológica. RESULTADOS: Inicialmente se incluyeron 185 pacientes en el estudio. En total, 17 pacientes abandonaron el estudio: un paciente en el G3 debido a un cambio de domicilio, uno en el G2 por razones de trabajo y 15 en el G1 aduciendo ausencia de resultados. De este modo, 168 pacientes completaron el estudio: 47 en G1, 61 en G2 y 60 en G3. De la población estudiada, el 57,1 % eran mujeres y el 42,9 % eran varones. El peso de los pacientes de los tres grupos descendió en cada una de las visitas, observándose al final del estudio una reducción de peso media de 4,37 kg, siendo esta de 5,34 kg en el G2, de 6,29 kg en el G3 y de 1,25 kg en el grupo de control (G1). También se observó una reducción de los niveles de colesterol en los tres grupos. El IMC mostró una reducción promedio general de -1,56, siendo esta de -1,70 en el G2, de -2,26 en el G3 y de 0,47 en el G1. En relación con el perfil lipídico, los niveles de colesterol total se redujeron en todos los grupos, siendo la mayor disminución la observada en el G3. Los niveles de triglicéridos se redujeron significativamente solo en dos grupos, G2 y G3 (-19,66 y -19,43, respectivamente). La hemoglobina glucosilada mostró una ligera disminución que no alcanzó la significación estadística. Los parámetros clínicamente relevantes fueron: a) G1 (control) frente a G2 (IMOAP): riesgo relativo (RR), 0,10 a 0,46; reducción del riesgo relativo (RRR), 0,54 a 0,90; reducción del riesgo absoluto (ARR), 0,30 a 0,61; número necesario a tratar (NNT), 3 a 2; b) G1 frente a G3 (IMOAP-PA): RR, 0,07 a 0,30; RRR, 0,70 a 0,93; ARR, 0,61 a 0,86; NNT: 2 a 1; c) G2 frente a G3: RR, 0,54 a 0,84; RRR, 0,16 a 0,46; ARR, 0,14 a 0,43; NNT, 7 a 2. CONCLUSIONES: la plataforma de salud digital que estimula la actividad física, agregada a una intervención motivacional en pacientes con sobrepeso u obesidad, aporta un beneficio adicional significativo en términos de resultados de pérdida de peso, de reducción del IMC y de mejora del perfil de lípidos en estas personas con un coste más efectivo


OBJECTIVES: to evaluate the effectiveness of three interventions for obesity, one of them including a platform that promotes physical activity. MATERIAL AND METHODS: a multicenter, randomized, controlled, parallel clinical trial that compared 3 arms with overweight or obese patients with a follow-up of 12 months. Patients were randomized into three groups for an intervention in a primary care center: G1: control group, which received the usual recommendations for losing weight according to the SEEDO 2000 Consensus; G2: motivational intervention for obesity (IMOAP) with a trained nurse and small, regular workgroups; G3: motivational intervention for obesity (IMOAP) plus use of a digital platform that records, monitors, and fosters physical activity (IWOPI). Variables collected included: weight, height, BMI, waist circumference, lipid parameters, blood pressure, and glycosylated hemoglobin. RESULTS: a total of 185 patients were initially included in the study. Seventeen patients left the study, and 168 patients completed the study: 47 in G1, 61 in G2, and 60 in G3. Of the population studied, 57.1 % were women. A general average weight reduction of 4.37 kg was seen at the end of the study - 5.34 kg in G2, 6.29 kg in G3, and 1.25 kg in the control group (G1). Cholesterol levels were also reduced in the three groups, but without reaching statistical significance. Clinically relevant parameters included: G1 (control) versus G2 (IMOAP): relative risk (RR), 0.10 to 0.46; relative risk reduction (RRR), 0.54 to 0.90; absolute risk reduction (ARR), 0.30 to 0.61; number needed to treat (NNT), 3 to 2; G1 versus G3 (IMOAP-PA): RR, 0.07 to 0.30; RRR, 0.70 to 0.93; ARR, 0.61 to 0.86; NNT: 2 to 1; G2 versus G3: RR, 0.54 to 0.84; RRR, 0.16 to 0.46; ARR, 0.14 to 0.43; NNT, 7 to 2. CONCLUSIONS: the digital health platform that fostered physical activity, added to a motivational intervention in overweight or obese patients, provided a significant additional benefit in terms of weight loss, BMI reduction, and lipid profile improvement in patients affected by overweight or obesity with a more effective cost


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Programas de Redução de Peso/métodos , Manejo da Obesidade , Atenção Primária à Saúde , Atividade Motora , Motivação , Resultado do Tratamento , Peso-Estatura , Índice de Massa Corporal , Circunferência da Cintura
15.
Orthop Nurs ; 39(2): 121-127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32218009

RESUMO

Obesity, a chronic multifactorial disease, has been on the rise in the United States in recent years. It paves a way to other chronic conditions and related morbidity and mortality. The treatment of obesity should have a chronic approach involving lifestyle modifications from the very beginning. Along with reduced calorie diet, increased physical activity, and behavior modifications, various short- and long-term pharmacological agents are available to help with the weight loss. For qualifying patients, selection of an appropriate agent based on its mechanism, efficacy, and safety profile as well as patient preference can provide desired outcomes. This medical weight management should be a multidisciplinary approach involving nurses to provide continuous patient education and motivation.


Assuntos
Tratamento Farmacológico/métodos , Obesidade/tratamento farmacológico , Programas de Redução de Peso/métodos , Benzazepinas/farmacologia , Benzazepinas/uso terapêutico , Bupropiona/farmacologia , Bupropiona/uso terapêutico , Combinação de Medicamentos , Tratamento Farmacológico/estatística & dados numéricos , Exercício Físico/fisiologia , Exercício Físico/psicologia , Frutose/análogos & derivados , Frutose/farmacologia , Frutose/uso terapêutico , Humanos , Liraglutida/farmacologia , Liraglutida/uso terapêutico , Naltrexona/farmacologia , Naltrexona/uso terapêutico , Obesidade/psicologia , Orlistate/farmacologia , Orlistate/uso terapêutico , Fentermina/farmacologia , Fentermina/uso terapêutico , Programas de Redução de Peso/normas
16.
Obes Facts ; 13(2): 201-212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32209798

RESUMO

BACKGROUND: Overweight and obesity after retirement are likely to be caused by unhealthy eating habits and the energy intake exceeding the energy expenditure. OBJECTIVES: This study was designed to assess the effects of two 12-week interventions involving, respectively, either regular physical activity or a modified lower-calorie diet on the anthropometric parameters and blood lipid profiles in overweight and obese retired miners with lipid disorders. DESIGN: The study participants (n = 30, aged 58.7 ± 4.1 years, body height 174.8 ± 7.3 cm, body weight 96.6 ± 13.9 kg) were randomly assigned to 2 intervention groups: the Nordic walking group (NW), which exercised with intensity from 60 to 70% of participants' maximal heart rates for 1 h 3 times a week, and the modified diet group (MD). Modification of the diet consisted of reducing the daily energy intake by 30%, increasing the dietary content of mono- and polyunsaturated fatty acids and dietary fiber, and reducing the proportion of saturated fatty acids. The variables assessed at baseline and after 6 and 12 weeks were: anthropometric parameters (body weight, fat mass content [FM], fat percentage [BF], BMI, waist circumference [WC], hip circumference [HC], and waist-to-hip ratio [WHR]) and blood lipid indicators (total cholesterol [TC], triglycerides [TG], low density lipoprotein cholesterol [LDL-C], and high density lip-oprotein cholesterol [HDL-C]). RESULTS: The body weight of the participants in the NW was lower at week 12 by an average of 5 kg, BMI by 6%, FB by 19%, FM by 15%, WC by 8%, HC by 6%, and WHR by 3%. In the MD, the respective decreases were 8 kg and 8, 25, 20, 6, 2, and 7%. In the MD, the postintervention concentrations of TC and TG were within the reference range. CONCLUSION: Both 12-week interventions improved the anthropometric parameters and blood lipid profiles of retired heavy manual workers, with the improvements being more pronounced in the dieting group.


Assuntos
Minas de Carvão , Dieta Redutora , Lipídeos/sangue , Obesidade/terapia , Sobrepeso/terapia , Aposentadoria , Caminhada/fisiologia , Idoso , Índice de Massa Corporal , Peso Corporal/fisiologia , Pesos e Medidas Corporais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Sobrepeso/sangue , Polônia , Triglicerídeos/sangue , Circunferência da Cintura , Relação Cintura-Quadril , Programas de Redução de Peso/métodos
17.
Trials ; 21(1): 139, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019609

RESUMO

BACKGROUND: A healthy lifestyle program that appeals to, and supports, obese New Zealand (NZ) European, Maori (indigenous) and Pasifika men to achieve weight loss is urgently needed. In Scotland, Football Fans in Training (FFIT), a weight management and healthy lifestyle program for overweight and obese men aged 35-65 years , delivered by community coaching staff at professional football clubs, has been shown to be beneficial and cost-effective. A pilot program inspired by FFIT but delivered by professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, improved physiological outcomes, and adherence to healthy lifestyle behaviors in overweight and obese men. The objective of this trial is to determine the effectiveness and cost-effectiveness of the Rugby Fans in Training New Zealand (RUFIT-NZ) program. METHODS: A pragmatic, two-arm, multi-center, randomized controlled trial involving 308 overweight and obese men aged 30-65 years, randomized to either an intervention group (n = 154) or a wait-list control group (n = 154). The intervention-group participated in the 12-week RUFIT-NZ program, a gender-sensitized, healthy lifestyle intervention adapted to the environment and cultural diversity of NZ and delivered through professional rugby clubs. Participants in the intervention group undergo physical training sessions, in addition to workshop-based sessions to learn about nutrition, physical activity, sleep, sedentary behavior, and a range of behavior-change strategies for sustaining a healthier lifestyle. The control group receives the program after 52 weeks. The primary outcome is change in body weight from baseline to 52 weeks. Secondary outcomes include change in body weight at 12 weeks; waist circumference, blood pressure, fitness, and lifestyle behaviors at 12 and 52 weeks; and cost-effectiveness. A process evaluation informed by the RE-AIM framework will evaluate potential implementation of RUFIT-NZ as an ongoing program in NZ after the trial. DISCUSSION: This trial will investigate the effectiveness and cost-effectiveness of the RUFIT-NZ program in overweight and obese NZ men. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered on 18 January 2019, according to the World Health Organization Trial Registration Data Set. Universal Trial Number, U1111-1245-0645.


Assuntos
Academias de Ginástica , Futebol Americano , Estilo de Vida Saudável , Estudos Multicêntricos como Assunto , Obesidade/terapia , Ensaios Clínicos Pragmáticos como Assunto , Programas de Redução de Peso/economia , Programas de Redução de Peso/métodos , Adulto , Idoso , Análise Custo-Benefício , Exercício Físico , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Comportamento Sedentário , Circunferência da Cintura , Perda de Peso
18.
Midwifery ; 82: 102624, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31931359

RESUMO

OBJECTIVES: To understand UK women's experiences of antenatal dietary advice for risk of food borne illness and weight gain. DESIGN: A systematic review and thematic synthesis of peer-reviewed qualitative studies. PubMed, MEDLINE, CINAHL and PMC databases were searched for articles published from January 2008 to June 2018. The search strategy combined terms for pregnancy with terms for body composition, weight change, food safety, nutrition, diet and qualitative terminology. Studies were eligible for inclusion if (1) they explored experiences of implementing advice received during pregnancy for nutrition, physical activity and/or weight gain, and (2) participants were women who had experienced maternity care in the UK. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool. FINDINGS: Of 25,688 articles identified by the search strategy, 20 studies were identified that met the inclusion criteria. Five major themes were recognised: control, barriers to diet and exercise, motivators, relationship with weight, and information, with a further 12 subthemes. The majority of studies reported on weight gain (n = 10). KEY CONCLUSIONS: Evidence shows that UK antenatal dietary advice is currently inconsistent, vague and overwhelming despite pregnancy being an excellent time for lifestyle change. Women are primarily driven by the health of their baby and desire support to facilitate positive changes. IMPLICATIONS FOR PRACTICE: Findings outline a wishlist which highlights a desire for tailored information on preventing weight gain, dietary requirements, safe physical activity and a deprioritisation of food safety guidelines. This provision should be delivered by HCP. e.g. midwives, in a sensitive and supportive way to bridge the gap between women's needs and the current antenatal provision.


Assuntos
Doenças Transmitidas por Alimentos/diagnóstico , Política Nutricional/tendências , Cuidado Pré-Natal/métodos , Programas de Redução de Peso/métodos , Feminino , Humanos , Gravidez , Cuidado Pré-Natal/normas , Pesquisa Qualitativa , Reino Unido , Programas de Redução de Peso/normas
19.
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
20.
Obesity (Silver Spring) ; 28(3): 510-520, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31984668

RESUMO

OBJECTIVE: Rural black communities bear a disproportionate burden of obesity. To increase reach among underserved groups, community-based weight loss and maintenance interventions are crucial. METHODS: The Diabetes Prevention Program (DPP) was adapted for rural black adults of faith to create The Wholeness, Oneness, Righteousness, Deliverance (WORD) trial, a group-based, community health worker-delivered weight loss intervention. A Weight Loss Only arm (16 sessions) was compared with a Weight Loss + Maintenance arm (16 + 12 sessions) in a cluster randomized controlled trial of 31 churches (n = 440). Weight and related behaviors were assessed at 0, 6, 12, and 18 months. RESULTS: The WORD produced weight loss from baseline to 6 months (percentage body weight change -2.47 [-3.13 to -1.80]). Among those who lost 5% of their baseline weight, there was a statistical trend of lower weight regain in the Weight Loss + Maintenance arm compared with control. Maintenance arm participants reported higher activity at 12 months. There were no between-arm differences at 18 months. CONCLUSIONS: The WORD produced weight loss from baseline to 6 months on par with that produced by other DPP adaptations for black communities, including adaptations using health professionals. Weight regain was also consistent with that reported in prior literature. Continuing sessions as part of the church's mission may foster adoption of DPP-based weight loss programs.


Assuntos
Obesidade/terapia , Programas de Redução de Peso/métodos , Afro-Americanos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Religião , População Rural
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