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A randomized trial of sequential and simultaneous multiple behavior change interventions for physical activity and fat intake

Changes in weight control behaviors and hedonic hunger during a 12-week commercial weight loss program

BackgroundGoal setting aids health-related behavior changes; however, the influence of different types of goals on weight loss remains unclear.ObjectiveWe aimed to investigate the association of 3 aspects of goal setting with weight and program dropout over a 24-week period.MethodsThis study was a prospective longitudinal analysis of participants in a 12-week digital behavioral weight loss program. Weight and engagement data for eligible participants (N=36,794) were extracted from the database. Eligible participants were adults in the United Kingdom who had enrolled in the program, had a BMI ≥25 kg/m2, and a weight reading recorded at baseline. Three aspects of goal setting were self-reported at enrollment: weight loss motivation (appearance, health, fitness, or self-efficacy), overall goal preference (low, medium, or high), and percentage weight loss goal (<5%, 5%-10%, or >10%). Weight was measured at 4, 12, and 24 weeks. Mixed models for repeated measures were used to explore the association between goals and weight across the 24-week period. To measure sustained weight change, the primary outcome was weight at 24 weeks. We explored dropout rates over the 24-week period by goal and whether engagement mediated the association between goals and weight loss.ResultsOf the 36,794 participants (mean 46.7, SD 11.1 years; 33,902/36,794, 92.14% female) included in the cohort, 13.09% (n=4818) reported weight at 24 weeks. Most participants set goals of 5%-10% weight loss (23,629/36,794, 64.22%), but setting goals for >10% was associated with greater weight loss (mean difference 5.21 kg, 95% CI 5.01-5.41; P<.001). There was no difference between goals of 5%-10% and <5% (mean difference 0.59 kg, 95% CI 0.00-1.18; P=.05). Appearance was the most prevalent motivational factor (14,736/36,794, 40.05%), but health and fitness were associated with greater weight losses (mean difference health vs appearance 1.40 kg, 95% CI 1.15-1.65; P<.001 and mean difference fitness vs appearance 0.38 kg, 95% CI 0.05-0.70; P=.03). Goal preference had no association with weight. Engagement was an independent predictor of weight loss but not a mediator of the effect of goal setting. At 24 weeks, those who set goals of >10% were less likely to drop out compared with 5%-10% goals (odds ratio [OR] 0.40, 95% CI 0.38-0.42; P<.001); those who liked to set overall high goals were more likely to drop out compared with medium goals (OR 1.20, 95% CI 1.11-1.29; P<.001); and those motivated by fitness or health were less likely to drop out compared with appearance (OR 0.92, 95% CI 0.85-0.995; P=.04 and OR 0.84, 95% CI 0.78-0.89; P<.001, respectively).ConclusionsSetting higher weight loss goals and being motivated by health or fitness were associated with greater weight loss and lower likelihood of dropout. Randomized trials for setting these types of goals are required to confirm causality.

To reach sustainability goals, researchers and policymakers must focus on addressing changes toward more pro-environmental behavior (PEB). Therefore, this study shows evidence-based perceptions of low- and high-cost behaviors and deduces recommendations for PEB interventions. We applied a multi-step mixed-method approach: First, a representative online survey was conducted to collect a general quantitative overview and classify low- and high-cost behavior based on past behavior and behavioral intentions. Second, a gamification intervention that aimed to gain quantitative data about certain behaviors and perceived low- and high-costs was conducted with university students. The results of the two studies showed that PEB can easily be categorized into high-, rather-high-, rather-low-, and low-cost behavior. However, this classification is not based on emission sectors, e.g., mobility, but on the specific behavior. Interventions can be recommended according to subjective costs: For example, low-cost behavior does not need additional interventions in most cases but must be maintained as is. According to the empirical findings, high-cost behavior needs top-down interventions, while rather-high- and rather-low-cost behavior requires bottom-up interventions to achieve behavior changes. In summary, managing interventions using this classification and focusing on high-impact behavior can lead to successful behavior changes and emission reductions.

Building Recipes and Understanding Nutrition for Cancer-survivor Health (BRUNCH)

The incorporation of causal inference in mediation analysis has led to theoretical and methodological advancements-effect definitions with causal interpretation, clarification of assumptions required for effect identification, and an expanding array of options for effect estimation. However, the literature on these results is fast-growing and complex, which may be confusing to researchers unfamiliar with causal inference or unfamiliar with mediation. The goal of this article is to help ease the understanding and adoption of causal mediation analysis. It starts by highlighting a key difference between the causal inference and traditional approaches to mediation analysis and making a case for the need for explicit causal thinking and the causal inference approach in mediation analysis. It then explains in as-plain-as-possible language existing effect types, paying special attention to motivating these effects with different types of research questions, and using concrete examples for illustration. This presentation differentiates 2 perspectives (or purposes of analysis): the explanatory perspective (aiming to explain the total effect) and the interventional perspective (asking questions about hypothetical interventions on the exposure and mediator, or hypothetically modified exposures). For the latter perspective, the article proposes tapping into a general class of interventional effects that contains as special cases most of the usual effect types-interventional direct and indirect effects, controlled direct effects and also a generalized interventional direct effect type, as well as the total effect and overall effect. This general class allows flexible effect definitions which better match many research questions than the standard interventional direct and indirect effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction:The psychological influence of food (PFS) and perceived barriers to lifestyle change (PBLC) were considered as predictors of body mass index and website tool utilization (TU) in an online weight loss program.Materials and Methodology:An archival analysis of all (N = 1361) overweight/obese (BMI M = 31.6 + 6.24 kg/m2), adult (M = 42.0 + 10.72 years) users (82.4% female) of an evidence-based, multidisciplinary Internet weight loss program was performed. Predictor variables included: PFS and PBLC, age, and longest maintained weight loss in relation to 1) BMI 2) TU.Results:Both PBLC and PFS were correlated with baseline BMI and TU. Regression analyses indicated that only PFS independently predicted BMI (p = .0001) and TU (p = .001) when the model included all predictor variables. One-way ANOVA indicated gender differences on both PBLC and PFS scores (p = .001). Subsequent regression analyses separated by gender showed that in females PFS predicted BMI (p = .0001) and TU (p = .005). For males no variable significantly predicted BMI (p’s > .05) however PBLC did predict TU (p = .008).Conclusions:Our findings suggest that when developing online weight loss programs clinical characteristics of the user could inform website algorithms to maximize website utilization. Gender differences indicated that for women it may be important to understand how factors related to the psychological influence of food impact utilization of online weight loss programs, however, for men broader barriers to lifestyle change is an important consideration.

Sol–gel derived zinc silicate phosphor films for full-color display applications

BackgroundObesity rates in adults continue to rise and effective treatment programs with a broad reach are urgently required. This paper describes the study protocol for a web-based randomized controlled trial (RCT) of a commercially available program for overweight and obese adult males and females. The aim of this RCT was to determine and compare the efficacy of two web-based interventions for weight loss and maintenance of lost weight.Methods/DesignOverweight and obese adult males and females were stratified by gender and BMI and randomly assigned to one of three groups for 12-weeks: waitlist control, or basic or enhanced online weight-loss. Control participants were re-randomized to the two weight loss groups at the end of the 12-week period. The basic and enhanced group participants had an option to continue or repeat the 12-week program. If the weight loss goal was achieved at the end of 12, otherwise on completion of 24 weeks of weight loss, participants were re-randomized to one of two online maintenance programs (maintenance basic or maintenance enhanced), until 18 months from commencing the weight loss program. Assessments took place at baseline, three, six, and 18 months after commencing the initial weight loss intervention with control participants repeating the initial assessment after three month of waiting. The primary outcome is body mass index (BMI). Other outcomes include weight, waist circumference, blood pressure, plasma markers of cardiovascular disease risk, dietary intake, eating behaviours, physical activity and quality of life.Both the weight loss and maintenance of lost weight programs were based on social cognitive theory with participants advised to set goals, self-monitor weight, dietary intake and physical activity levels. The enhanced weight loss and maintenance programs provided additional personalized, system-generated feedback on progress and use of the program. Details of the methodological aspects of recruitment, inclusion criteria, randomization, intervention programs, assessments and statistical analyses are described.DiscussionImportantly, this paper describes how an RCT of a currently available commercial online program in Australia addresses some of the short falls in the current literature pertaining to the efficacy of web-based weight loss programs.Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12610000197033

BackgroundObesity remains a serious issue in many countries. Web-based programs offer good potential for delivery of weight loss programs. Yet, many Internet-delivered weight loss studies include support from medical or nutritional experts, and relatively little is known about purely web-based weight loss programs.ObjectiveTo determine whether supportive features and personalization in a 12-week web-based lifestyle intervention with no in-person professional contact affect retention and weight loss.MethodsWe assessed the effect of different features of a web-based weight loss intervention using a 12-week repeated-measures randomized parallel design. We developed 7 sites representing 3 functional groups. A national mass media promotion was used to attract overweight/obese Australian adults (based on body mass index [BMI] calculated from self-reported heights and weights). Eligible respondents (n = 8112) were randomly allocated to one of 3 functional groups: information-based (n = 183), supportive (n = 3994), or personalized-supportive (n = 3935). Both supportive sites included tools, such as a weight tracker, meal planner, and social networking platform. The personalized-supportive site included a meal planner that offered recommendations that were personalized using an algorithm based on a user’s preferences for certain foods. Dietary and activity information were constant across sites, based on an existing and tested 12-week weight loss program (the Total Wellbeing Diet). Before and/or after the intervention, participants completed demographic (including self-reported weight), behavioral, and evaluation questionnaires online. Usage of the website and features was objectively recorded. All screening and data collection procedures were performed online with no face-to-face contact.ResultsAcross all 3 groups, attrition was high at around 40% in the first week and 20% of the remaining participants each week. Retention was higher for the supportive sites compared to the information-based site only at week 12 (P = .01). The average number of days that each site was used varied significantly (P = .02) and was higher for the supportive site at 5.96 (SD 11.36) and personalized-supportive site at 5.50 (SD 10.35), relative to the information-based site at 3.43 (SD 4.28). In total, 435 participants provided a valid final weight at the 12-week follow-up. Intention-to-treat analyses (using multiple imputations) revealed that there were no statistically significant differences in weight loss between sites (P = .42). On average, participants lost 2.76% (SE 0.32%) of their initial body weight, with 23.7% (SE 3.7%) losing 5% or more of their initial weight. Within supportive conditions, the level of use of the online weight tracker was predictive of weight loss (model estimate = 0.34, P < .001). Age (model estimate = 0.04, P < .001) and initial BMI (model estimate = -0.03, P < .002) were associated with frequency of use of the weight tracker.ConclusionsRelative to a static control, inclusion of social networking features and personalized meal planning recommendations in a web-based weight loss program did not demonstrate additive effects for user weight loss or retention. These features did, however, increase the average number of days that a user engaged with the system. For users of the supportive websites, greater use of the weight tracker tool was associated with greater weight loss.

BackgroundEnhancing physical activity in overweight and obese individuals is an important means to promote health in this target population. The Health Action Process Approach (HAPA), which was the theoretical framework of this study, focuses on individual self-regulation variables for successful health behavior change. One key self-regulation variable of this model is action control with its three subfacets awareness of intentions, self-monitoring and regulatory effort. The social context of individuals, however, is usually neglected in common health behavior change theories. In order to integrate social influences into the HAPA, this randomized controlled trial investigated the effectiveness of a dyadic conceptualization of action control for promoting physical activity.Methods/DesignThis protocol describes the design of a single-blind randomized controlled trial, which comprises four experimental groups: a dyadic action control group, an individual action control group and two control groups. Participants of this study are overweight or obese, heterosexual adult couples who intend to increase their physical activity. Blocking as means of a gender-balanced randomization is used to allocate couples to conditions and partners to either being the target person of the intervention or to the partner condition. The ecological momentary intervention takes place in the first 14 days after baseline assessment and is followed by another 14 days diary phase without intervention. Follow-ups are one month and six months later. Subsequent to the six-months follow-up another 14 days diary phase takes place.The main outcome measures are self-reported and accelerometer-assessed physical activity. Secondary outcome measures are Body Mass Index (BMI), aerobic fitness and habitual physical activity.DiscussionThis is the first study examining a dyadic action control intervention in comparison to an individual action control condition and two control groups applying a single-blind randomized control trial. Challenges with running couples studies as well as advantages and disadvantages of certain design-related decisions are discussed. This RCT was funded by the Swiss National Science Foundation (PP00P1_133632/1) and was registered on 27/04/2012 at http://www.isrctn.com/ISRCTN15705531.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1321) contains supplementary material, which is available to authorized users.

PARE0013 ‘FIND A NUDGE’ AND OTHER TIPS TO MAINTAIN YOUR LEVEL OF PHYSICAL ACTIVITY FOR A LONGER TIME

Although outcome expectancies are regarded as key determinants of health behavior change, studies on the role of their degree of fulfillment in long-term activity changes are lacking. This study investigated the impact of (un-)fulfilled outcome expectancies (OE) on (un-)successful attempts to increase physical activity, assuming that disengagement is the logical consequence of perceived futility. Participants (n = 138) of a longitudinal cohort study with three measurement waves were assigned to eight different groups according to a staging algorithm of their self-reported, 1-year-long physical activity behavior track. Stages were validated by objective changes in objective fitness, e.g., Physical Working Capacity (PWC). Social cognitive variables, self-efficacy, proximal and distal OE, and fulfillment of OE, were assessed via self-report. Discriminant analyses revealed that OE fulfillment was the predominant predictor for differentiating between successful and unsuccessful behavior change. Amongst OE, proximal OE concerning emotional rewards, in conjunction with action self-efficacy, further improved discriminatory power. OE adjustment warranting hedonic rewards appears to be a crucial mechanism as it facilitates long-term changes through interventions aimed at increasing physical activity rates. Theoretical models might benefit by including the concept of fulfilled expectations acting in terms of feedback loops between volitional and motivational processes.

BACKGROUND:The promotion of health in adolescents with mental disorders depends on their levels of self-care empowerment. Self-efficacy is a significant prerequisite for successful self-management and behavior change in adolescents with mental disorders. The present study was conducted to explain the concept of care self-efficacy in adolescents with mental disorders.MATERIALS AND METHODS:This qualitative study was carried out using the conventional content analysis approach. Semi-structured interviews (n = 34) were conducted with adolescents having mental disorders, their families, and healthcare providers. The participants were selected from neurology and psychiatry clinics affiliated with University of Medical Sciences using the purposeful sampling method in 2021. Data were analyzed according to Graneheim and Lundman method.RESULTS:According to the findings of content analysis, four main themes were derived from the data: “health information-seeking behavior,” “adaptation of life to the disease and treatment conditions,” “adaptive coping,” and “social self-care.”CONCLUSION:Based on the findings, the promotion of adaptive styles and social support is effective in acquiring social competencies. As a result, policymakers are suggested to design health-oriented educational programs based on care self-efficacy principles to promote health in adolescents with mental disorders.

reports of a relationship between altitude and circulating levels of leptin suggest a possible role of hypoxia in leptin regulation. However, studies on the changes in plasma leptin levels at altitude are controversial, with some showing an increase and others suggesting no change or a fall in these