Behavioral Management Program Research Articles

The Role of Behavioral Management in Enhancing Clinical Care and Efficiency, Minimizing Social Disruption, and Promoting Welfare in Captive Primates.

Medical procedures necessary for routine care can induce stress in both the veterinary and human clinical situations. In the research environment, nonhuman primates undergo procedures like physical examination, blood sampling, and intravenous drug or fluid administration either as a part of routine veterinary care or during the modeling of clinical disease and interventions under study. Behavioral management techniques, such as training for cooperation, allow caregivers to train primates to voluntarily engage in various medical procedures. This approach reduces stress and anxiety associated with necessary procedures, thereby enhancing efficiency and minimizing the invasiveness of medical care. Consequently, veterinary evaluation and care can be provided without compromise, resulting in enhanced clinical outcomes and overall better health. In this study, we explored the impact of the behavioral management program implemented at our center on a subset of animals undergoing routine veterinary care, focusing on the overall experience, including animal welfare, scientific rigor, and efficiency in terms of economics and time. We investigated its impact on key factors, such as the total procedure and recovery time, incidence of side effects, and welfare indicators, revealing a significant positive influence on animal care. Furthermore, through case studies, we illustrate how behavioral management facilitates timely medical care and monitoring, effectively mitigating stressors that could otherwise impair health and welfare, enabling the provision of care that would have otherwise been unachievable. A thoughtfully designed primate behavioral management program, integrating cooperation and participation with veterinary care, forms the cornerstone of superior animal welfare, enhanced clinical care, and more accurate scientific outcomes.

Intermittent Energy Restriction for Adolescents With Obesity

Adolescent obesity requires effective and accessible treatment. Intensive dietary interventions have the potential to be used as adjunctive therapy for behavioral weight management. To examine the effectiveness of 2 diet therapies, delivered as part of an intensive behavioral weight management intervention, in adolescents with metabolic complications associated with obesity. This multisite, 52-week randomized clinical trial was conducted from January 31, 2018, to March 31, 2023, at 2 tertiary pediatric centers in Australia. Adolescents (aged 13-17 years) with obesity and 1 or more associated complications were included. Intensive behavioral interventions, delivered by a multidisciplinary team, comparing intermittent energy restriction (IER) or continuous energy restriction (CER), with 3 phases: very low-energy diet (weeks 0-4), intensive intervention (weeks 5-16), and continued intervention and/or maintenance (weeks 17-52). The primary outcome was body mass index (BMI) z score at 52 weeks in the IER vs CER group. Anthropometry, body composition, and cardiometabolic health were assessed at baseline and 52 weeks. The BMI z score and percentiles were determined using Centers for Disease Control and Prevention growth charts. Insulin resistance, dyslipidemia, and elevated hepatic function were assessed. A total of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) were enrolled, 71 in the IER group and 70 in the CER group, and 97 (68.8%) completed the intervention, 43 in the IER group and 54 in the CER group. At week 52, both groups had reduced BMI z scores (estimated marginal mean change, -0.28 [95% CI, -0.37 to -0.20] for IER and -0.28 [95% CI, -0.36 to -0.20] for CER) and reduced BMI expressed as a percentage of the 95th percentile (estimated marginal mean change, -9.56 [95% CI, -12.36 to -6.83] for IER and -9.23 [95% CI, -11.82 to -6.64] for CER). No differences were found in body composition or cardiometabolic outcomes between the groups. Both groups had a reduction in the occurrence of insulin resistance (from 52 of 68 [76.5%] to 32 of 56 [57.1%] in the IER group and from 59 of 68 [86.8%] to 31 of 60 [57.1%] in the CER group) at week 16; however, at week 52, this effect was observed in the CER group only (from 59 of 68 [86.7%] to 30 of 49 [61.2%]). The occurrence of dyslipidemia was unchanged between baseline and week 52 (60 of 137 [42.6%] and 37 of 87 [42.5%], respectively), with a small improvement in occurrence of impaired hepatic function tests (37 of 139 [27.0%] and 15 of 87 [17.2%], respectively). No differences were found in dyslipidemia or hepatic function between groups. These findings suggest that for adolescents with obesity-associated complications, IER can be incorporated into a behavioral weight management program, providing an option in addition to CER and offering participants more choice. http://anzctr.org.au Identifier: ACTRN12617001630303.

Which components of behavioral weight management programs are essential for weight loss in people living with obesity? A rapid review of systematic reviews.

The optimal treatment and organization of care for people with obesity is one of the greatest challenges facing today's health services. While surgery and pharmacotherapy offer effective treatment options for some people with obesity, behavioral interventions are important to support long-term behavioral change. However, little is known about the most effective components of behavioral interventions, and this is especially the case for people with complex or severe obesity (i.e. body mass index [BMI] > 35 kg/m2). Accordingly, the current rapid review aimed to identify which behavior change techniques (BCTs) are effective for weight loss in adults with (severe) obesity. A secondary aim was to review the effects of BCTs on dietary behaviors and physical activity, and psychological outcomes, recognizing that behavioral interventions commonly target these. A search of Scopus, Ovid Medline, and Web of Science resulted in 1227 results, with 22 reviews eligible for inclusion. The most commonly reported BCTs were self-monitoring and goal setting, but these had variable effects on weight in adults with obesity. Combining these BCTs with other self-regulatory techniques led to increased weight loss. Further, for adults with severe obesity, so-called 'nudge' techniques and self-regulatory techniques were associated with greater weight loss. Three reviews also found that while self-monitoring increased physical activity, behavioral commitments increased changes to dietary behaviors. BCTs were not associated with psychological well-being. The review confirms that behavioral interventions have an impact in weight management, including for individuals with more complex or severe obesity, but highlights the need for further investigation of their use within clinical settings.

A predictive model for medium-term weight loss response in people with type 2 diabetes engaging in behavioural weight management interventions.

To develop and evaluate prediction models for medium-term weight loss response in behavioural weight management programmes. We conducted three longitudinal analyses using the Action for HEalth in Diabetes (LookAHEAD) trial, Weight loss Referrals for Adults in Primary care (WRAP) trial, and routine data from the National Health Service Greater Glasgow and Clyde Weight Management Service (NHS-GGCWMS). We investigated predictors of medium-term weight loss (>5% body weight) over 3 years in NHS-GGCWMS and, separately, predictors of weight loss response in LookAHEAD over 4 years. We validated predictors in both studies using WRAP over 5 years. Predictors of interest included demographic and clinical variables, early weight change in-programme (first 4 weeks) and overall in-programme weight change. In LookAHEAD and WRAP the only baseline variables consistently associated with weight loss response were female sex and older age. Of 1152 participants in NHS-GGCWMS (mean age 57.8 years, 60% female, type 2 diabetes diagnosed for a median of 5.3 years), 139 lost weight over 3 years (12%). The strongest predictor of weight loss response was early weight change (odds ratio 2.22, 95% confidence interval 1.92-2.56) per 1% weight loss. Losing 0.5% weight in the first 4 weeks predicted medium-term weight loss (sensitivity 89.9%, specificity 49.5%, negative predictive value 97.3%). Overall in-programme weight change was also associated with weight loss response over 3 years in NHS-GGCWMS and over 5 years in WRAP. Not attaining a weight loss threshold of 0.5% early in weight management programmes may identify participants who would benefit from alternative interventions.

Association between a national behavioral weight management program and real-world weight change

ObjectiveIn a national cohort of Veterans, weight change was compared between participants in a US Department of Veterans Affairs (VA) behavioral weight management program (MOVE!) and matched non-participants, and between high-intensity and low-intensity participants. MethodsRetrospective cohort study of Veterans with 1 + MOVE! visits in 2008–2017 were matched to MOVE! non-participants via sequential stratification. Percent weight change up to two years after MOVE! initiation of participants and non-participants was modeled using generalized additive mixed models, and 1-year weight change of high-intensity or low-intensity participants was also compared. ResultsMOVE! participants (n = 499,696) and non-participant controls (n = 1,336,172) were well-matched, with an average age of 56 years and average BMI of 35. MOVE! participants lost 1.4 % at 12 months and 1.2 % at 24 months, which was 0.89 % points (95 % CI: 0.83–0.96) more at 12 months than non-participants and 0.55 % points (95 % CI: 0.41–0.68) more at 24 months. 9.1 % of MOVE! participants had high-intensity use in one year, and they had 2.38 % point (95 % CI: 2.25–2.52) greater weight loss than low-intensity participation at 12 months (2.8 % vs 0.4 %). ConclusionsParticipation in VA’s system-wide behavioral weight management program (MOVE!) was associated with modest weight loss, suggesting that program modifications are needed to increase Veteran engagement and program effectiveness. Future research should further explore how variations in program delivery and the use of newer anti-obesity medications may impact the program’s effectiveness.

The Effect of Family-Based Behavioral Management Program Training on Dysfunctional Attitudes and Psychological Well-Being in Adolescents with a Tendency towards Drug Use

The Effect of Family-Based Behavioral Management Program Training on Dysfunctional Attitudes and Psychological Well-Being in Adolescents with a Tendency towards Drug Use

A 12-month randomised controlled trial using intensive dietary interventions for adolescents with obesity associated complications

Adolescent obesity requires effective and accessible intervention options and there is potential for intensive dietary interventions to be used as adjunctive therapy to behavioural weight management for some individuals(1). The aim of this study was to determine the effect of two novel diet therapies, delivered in the as part of an intensive behavioural weight management intervention, in adolescents with metabolic complications associated with obesity. The Fast Track to Health study (HREC/17/SCHN/164; ACTRN12617001630303) was a multi-site 52-week RCT, conducted 2018 – 2023, comparing a very-low-energy diet (800kcal/day) followed by i) an intermittent energy restricted (IER) diet; and ii) a continuous energy restricted diet (CER), for adolescents (13-17years) with ≥1 obesity associated complication. Interventions were delivered as part of an intensive behavioural weight management intervention by a multidisciplinary team2. Anthropometry, body composition and cardiometabolic health were assessed at baseline and week-52. The primary outcome was change in BMI z-score at week-52. Dyslipidaemia was defined as HDL <1.03mmol/L and/or triglycerides ≥1.7mmol/l, and elevated liver function tests (LFTs) as ALT and/or GGT ≥1.5 upper limit of 30U/L3. The difference in BMI z-score between groups at week-52 (±4) was assessed using a t-test. Mixed models was used to investigate changes over time. Descriptive statistics were used to describe participants above and below clinical cut-points at baseline and week-52. In total, 141 adolescents (70 female) were enrolled and 97 (48 female) completed the intervention. At week-52, BMI z-score reduced by −0.23 [95%CI −0.37 to −0.22], BMI expressed as a percentage of 95th percentile reduced by −8.86 [95%CI −12.46 to −7.47] and Fat Mass Index reduced by −1.49 [95%CI −2.36 to −1.08]. There was no significant difference for weight or cardiometabolic outcomes between diet groups. The occurrence of dyslipidaemia was unchanged between baseline and week-52 (n = 60 [43%] and n = 37 [43%] respectively) and a small improvement in the occurrence of impaired LFTs (n = 37 [27%] to n = 15 [17.2%] respectively). There were no differences in change of occurrence of dyslipidaemia or impaired LFTs between intervention groups. These findings suggest that both IER and CER, delivered as part of an intensive behavioural weight management program, are equally effective for improving weight and cardiometabolic outcomes for adolescents with obesity.

Cross-model validation of public health microsimulation models; comparing two models on estimated effects of a weight management intervention

BackgroundHealth economic modelling indicates that referral to a behavioural weight management programme is cost saving and generates QALY gains compared with a brief intervention. The aim of this study was to conduct a cross-model validation comparing outcomes from this cost-effectiveness analysis to those of a comparator model, to understand how differences in model structure contribute to outcomes.MethodsThe outcomes produced by two models, the School for Public Health Research diabetes prevention (SPHR) and Health Checks (HC) models, were compared for three weight-management programme strategies; Weight Watchers (WW) for 12 weeks, WW for 52 weeks, and a brief intervention, and a simulated no intervention scenario. Model inputs were standardised, and iterative adjustments were made to each model to identify drivers of differences in key outcomes.ResultsThe total QALYs estimated by the HC model were higher in all treatment groups than those estimated by the SPHR model, and there was a large difference in incremental QALYs between the models. SPHR simulated greater QALY gains for 12-week WW and 52-week WW relative to the Brief Intervention. Comparisons across socioeconomic groups found a stronger socioeconomic gradient in the SPHR model. Removing the impact of treatment on HbA1c from the SPHR model, running both models only with the conditions that the models have in common and, to a lesser extent, changing the data used to estimate risk factor trajectories, resulted in more consistent model outcomes.ConclusionsThe key driver of difference between the models was the inclusion of extra evidence-based detail in SPHR on the impacts of treatments on HbA1c. The conclusions were less sensitive to the dataset used to inform the risk factor trajectories. These findings strengthen the original cost-effectiveness analyses of the weight management interventions and provide an increased understanding of what is structurally important in the models.

Association Between a National Behavioral Weight Management Program and Veterans Affairs Health Expenditures.

The association between participation in a behavioral weight intervention and health expenditures has not been well characterized. We compared Veterans Affairs (VA) expenditures of individuals participating in MOVE!, a VA behavioral weight loss program, and matched comparators 2 years before and 2 years after MOVE! initiation. Retrospective cohort study of Veterans who had one or more MOVE! visits in 2008-2017 who were matched contemporaneously to up to 3 comparators with overweight or obesity through sequential stratification on an array of patient characteristics, including sex. Baseline patient characteristics were compared between the two cohorts through standardized mean differences. VA expenditures in the 2 years before MOVE! initiation and 2 years after initiation were modeled using generalized estimating equations with a log link and distribution with variance proportional to the standard deviation (gamma). MOVE! participants (n=499,696) and comparators (n=1,336,172) were well-matched, with an average age of 56, average body mass index of 35, and similar total VA expenditures in the fiscal year before MOVE! initiation ($9662 for MOVE! participants and $10,072 for comparators, standardized mean difference=-0.019). MOVE! participants had total expenditures that were statistically lower than matched comparators in the 6 months after initiation but modestly higher in the 6 months to 2 years after initiation, though differences were small in magnitude (1.0%-1.6% differences). The VA's system-wide behavioral weight intervention did not realize meaningful short-term health care cost savings for participants.

Behavioral weight management use in the Veterans Health Administration: Sociodemographic and health correlates

IntroductionOver 40 % of United States Veterans Health Administration (VHA) primary care patients have obesity. Few patients use VHA's flagship weight management program, MOVE! and there is little information on other behavioral weight management program use. MethodsThe national United States cohort included over 1.5 million primary care patients with obesity, age 18–79, based on VHA administrative data. Gender stratified multivariable logistic regression identified correlates of weight management use in the year after a patient's first primary care appointment (alpha of 0.05). Weight management use was defined as MOVE! or nutrition clinic visits. ResultsThe cohort included 121,235 women and 1,521,547 men with 13 % and 7 % using weight management, respectively. Point estimates for specific correlates of use were similar between women and men, and across programs. Black patients were more likely to use weight management than White patients. Several physical and mental health diagnoses were also associated with increased use, such as sleep apnea and eating disorders. Age and distance from VHA were negatively associated with weight management use. ConclusionsWhen assessing multiple types of weight management visits, weight management care in VHA appears to be used more often by some populations at higher risk for obesity. Other groups may need additional outreach, such as those living far from VHA. Future work should focus on outreach and prevention efforts to increase overall use rates. This work could also examine the benefits of tailoring care for populations in greatest need.

Athletic Behavioral Practices in the Perspective of the Confucian Values and Team Cohesion towards a Behavior Management Program in Jiangsu Province, China

This study examined the interplay between Confucian values, athletic behavior, and team cohesion among student-athletes. A diverse cohort of student-athletes, spanning various grade levels and genders, participated in the research. The study delves into six key Confucian values: cultivation of appropriate behavior, filial piety, respect for others, adherence to societal norms, respect for authority, and rituals and etiquette. Results indicate a robust commitment to these values in athletic conduct, with particular emphasis on filial piety and respect for authority. Team cohesion assessments reveal strong team identities, positive moods, and a sense of belonging among athletes. Furthermore, correlations between adherence to Confucian values and team cohesion were observed, with ethical behavior and the importance of rituals and etiquette positively impacting team identity. Recommendations include ethical conduct training, mentorship programs, and continued research to enhance athlete development and foster a culturally aware and cohesive sports environment.

Cardiovascular diseases and community mental health

<p class="Default">Cardiovascular diseases (CVDs) are cited as the deadliest of illnesses. Their incidence and prevalence around the world are steadily rising. CVDs are the cause of approximately one-third of all deaths in the world. It has been stated in empirical studies over the years that poor socioeconomic status, the lack of social support, stress at work and in the family, depression, and psychosocial risk factors such as anxiety and feelings of hostility aggravate the risk of developing coronary heart disease and also worsen the clinical course and prognosis. Additionally, psychobiological, and behavioral mechanisms have been identified in this context. Psychosocial risk factors should be identified in clinical practice and medical results shared with individuals with CVDs, who should also be screened for anxiety, stress, and stress management, as well as for symptoms of depression. Individuals at risk or who are diagnosed as displaying symptoms of anxiety and depression should be referred to psychiatric professionals to ensure that they receive assistance. Cardiac rehabilitation may involve psychosocial interventions that include cognitive behavioral therapy, problem-solving therapy, and stress management programs, applied on their own or together with other interventions. The aim of this review article is to examine CVDs and community mental health, determine which applications may be adopted as standard practice in this context, and raise awareness about this topic among the public and especially among health professionals. </p>

Development of a novel primate welfare assessment tool for research macaques.

Primates are important species for biomedical research and ensuring their good welfare is critical for research translatability and ethical responsibility. Systematic animal welfare assessments can support continuous programme improvements and build institutional awareness of areas requiring more attention. A multi-facility, collaborative project aimed to develop and implement a novel primate welfare assessment tool (PWAT) for use with research macaques. PWAT development involved: establishing an internal focus group of primate subject matter experts, identifying animal welfare categories and descriptors based on literature review, developing a preliminary tool, beta-testing the tool to ensure practicality and final consensus on descriptors, finalising the tool in a database with semi-automated data analysis, and delivering the tool to 13 sites across four countries. The tool uses input- and outcome-based measures from six categories: physical, behavioural, training, environmental, procedural, and culture of care. The final tool has 133 descriptors weighted based upon welfare impact, and is split into three forms for ease of use (room level, site level, and personnel interviews). The PWAT was trialled across facilities in March and September 2022 for benchmarking current macaque behavioural management programmes. The tool successfully distinguished strengths and challenges at the facility level and across sites. Following this benchmarking, the tool is being applied semi-annually to assess and monitor progress in behavioural management programmes. The development process of the PWAT demonstrates that evidence-based assessment tools can be developed through collaboration and consensus building, which are important for uptake and applicability, and ultimately for promoting global improvements in research macaque welfare.

A cross-sectional survey study exploring provision and delivery of expanded community tier 2 behavioural weight management services in England.

Guidelines recommend provision of local behavioural weight management (tier 2) programmes for adults living with overweight and obesity. Following the publication of the UK Government's publication 'Tackling Obesity: empowering adults and children to live healthier lives' in July 2021, Government invested around £30 million of additional funding to support the expansion of local authority commissioned tier 2 provision for adults living with excess weight. We conducted a cross-sectional survey study to scope the types of services available, to whom they were made available, and barriers and facilitators to service delivery. An e-survey was disseminated to local authority commissioned tier 2 service providers in England from September to October 2022. Through a combination of closed and open (qualitative) questions, the survey collected data on referral routes, participant eligibility criteria, service content and format, and challenges and enablers to service delivery. Quantitative data were analysed descriptively whilst thematic content analysis was applied to qualitative data. We received 52 responses (estimated response rate = 59%) representing all nine England regions and 89 unique local authorities. Most services were multi-component (84.3%), were 12 weeks duration (78.0%), were group-based (90.0%), were primarily delivered in-person (86.0%), and were free to participants (90.2%). Five responses indicated provision of support for other health and wellbeing issues, for example, mental health, assistance with debt. To improve future WMS service commissioning and delivery, WMS providers need to be allowed adequate time and resource to properly prepare for service delivery. Referral systems and criteria should be made clear and straightforward to both referrers and service users, and strategies to manage surplus referrals should be explored.

Real World Use of Anti-Obesity Medications and Weight Change in Veterans.

Anti-obesity medications (AOMs) can be initiated in conjunction with participation in the VA national behavioral weight management program, MOVE!, to help achieve clinically meaningful weight loss. To compare weight change between Veterans who used AOM + MOVE! versus MOVE! alone and examine AOM use, duration, and characteristics associated with longer duration of use. Retrospective cohort study using VA electronic health records. Veterans with overweight or obesity who participated in MOVE! from 2008-2017. Weight change from baseline was estimated using marginal structural models up to 24months after MOVE! initiation. The probability of longer duration of AOM use (≥ 180days) was estimated via a generalized linear mixed model. Among MOVE! participants, 8,517 (1.6%) used an AOM within 24months after MOVE! initiation with a median of 90days of cumulative supply. AOM + MOVE! users achieved greater weight loss than MOVE! alone users at 6 (3.2% vs. 1.6%, p < 0.001), 12 (3.4% vs. 1.4%, p < 0.001), and 24months (2.7% vs. 1.5%, p < 0.001), and had a greater probability of achieving ≥ 5% weight loss at 6 (38.8% vs. 26.0%, p < 0.001), 12 (43.1% vs. 28.4%, p < 0.001), and 24months (40.4% vs. 33.3%, p < 0.001). Veterans were more likely to have ≥ 180days of supply if they were older, exempt from medication copays, used other medications with significant weight-gain, significant weight-loss, or modest weight-loss side effects, or resided in the West North Central or Pacific regions. Veterans were less likely to have ≥ 180days of AOM supply if they had diabetes or initiated MOVE! later in the study period. AOM use following MOVE! initiation was uncommon, and exposure was time-limited. AOM + MOVE! was associated with a higher probability of achieving clinically significant weight loss than MOVE! alone.

Estimation of HbA1c after weight loss using a beta-regression for an economic evaluation of a behavioural weight management programme from the GLoW trial: a methodological study

BackgroundIn economic evaluations, average intervention effects are usually applied to a population. However, this fails to reflect the change in the distribution of HbA1c due to heterogeneous responses to weight loss. We aimed to investigate whether allowing heterogeneous treatment effects using a beta regression better represented the distribution of HbA1c after a weight-loss intervention, and how this affected cost effectiveness. MethodsThe Glucose Lowering through Weight Management (GLoW) trial evaluated the effectiveness of a diabetes education and weight-loss intervention against a standard diabetes education programme. Adults diagnosed with type 2 diabetes within 3 years were recruited from Clinical Commissioning Groups across 159 sites in England from July 20, 2018, to July 22, 2018. Ethics approval (18/ES/0048) and participant informed consent were obtained. Considering the between-treatment-arm difference in HbA1c after 12 months, we compared a mean-effect estimated from a mixed-effects regression to a heterogeneous effect estimated from a beta regression performed on 12-month HbA1c conditional on baseline HbA1c, gender, diabetes duration and intervention group. We used the School of Public Health Research (SPHR) Diabetes Treatment model to apply these treatment effects and evaluate the lifetime NHS costs and quality-adjusted life-years (QALYs), discounted at 3·5%. The microsimulation model estimated diabetes-related health outcomes using the UK Prospective Diabetes Study Outcomes Model 2 risk equations and risk factor trajectory equations, alongside estimating diabetes remission, osteoarthritis, and cancer. We calculated the incremental net benefit (INB) of the intervention using a £20 000 per QALY valuation, by deterministic analysis. The GLoW trial is registered with the ISRCTN Registry, ISRCTN18399564. FindingsThe trial recruited 577 participants (mean age 60 years; 278 [53%] female, 247 [47%] male; 474 [91%] white ethnic background). Applying heterogeneous HbA1c changes better reproduced the skewness in post-intervention HbA1c than applying a mean-effect (Kolmogorov-Smirnov test p=0·02 compared with p=0·0000007). The beta-regression method suggested the intervention was more cost-effective, estimating an INB of £736 per person, compared with £584 when applying the mean-effect. InterpretationAlternative regression specification methods should be considered when evaluating the cost-effectiveness of interventions if the key intervention outcomes are not normally distributed. However, this alternative method requires further investigation to conclude its appropriateness in evaluating cost-effectiveness in different contexts. FundingNational Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (Reference Number RP-PG0216-20010).

Non-nutritive sweetened beverages versus water after a 52-week weight management programme: a randomised controlled trial

Background/objectiveSugar-sweetened beverages are a substantial source of dietary sugar that can contribute to weight gain and the risk of type 2 diabetes. Dietary guidelines recommend non-nutritive sweetened (NNS) beverages to reduce sugar consumption, however, there is a need for long-term randomised controlled trials on their use. We aimed to compare the effects of NNS beverages and water on body weight during weight loss and maintenance in a behavioural weight management programme.MethodsIn this parallel-group, open-label, controlled equivalence trial, adults with a BMI of 27–35 kg/m2 who regularly consumed cold beverages were randomised 1:1 to water or NNS beverages. Participants underwent a group behavioural weight management programme comprising weekly (during the 12-week weight-loss phase) then monthly (during the 40-week weight-maintenance phase) meetings. The primary endpoint was weight change at week 52 (equivalence: two-sided P > 0.05). Secondary endpoints included changes in anthropometrics, cardiometabolic risk factors, appetite and activity levels.ResultsOf 493 participants randomised (water: n = 246; NNS beverages: n = 247), 24.1% were NNS-naïve. At week 52, water and NNS beverages were non-equivalent, with significantly greater weight loss in the NNS beverages group. Participants consuming water maintained a weight loss of 6.1 kg over 52 weeks versus 7.5 kg with NNS beverages (difference [90% CI]: 1.4 kg [–2.6, –0.2]; p < 0.05).ConclusionsDuring a 52-week behavioural weight management programme, water and NNS beverages were non-equivalent, with weight loss maintained to a statistically greater extent with NNS beverages compared with water. However, this difference was not clinically significant.Clinical trial registrationThis trial is registered with ClinicalTrials.gov: NCT02591134

Good behavior game - study protocol for a randomized controlled trial of a preventive behavior management program in a Swedish school context.

Early conduct problems and school failure are prominent risk factors for several adverse outcomes in later life. With the potential of reaching many children at early stages of their life, school-based interventions constitute a valuable approach to universal prevention. Good behavior game (GBG) is a promising school-based behavior management program, having shown immediate reductions in conduct problems along with several long-term positive effects. Adapting interventions to new contexts may however affect their effectiveness. The current study aims to evaluate the effectiveness of a Swedish adaption of GBG under pragmatic conditions. The intervention is hypothesized to reduce conduct problems in the classroom (primary outcome). Secondary analyses will investigate changes in conduct problems in common school areas, classroom climate, teacher collective efficacy, on-task behavior, as well as investigating behavioral management practices, implementation, and barriers to implementation. This is a cluster-randomized trial with two parallel groups. Schools will be randomized (1,1, stratified by their areas sociodemographic index score) to be provided training in GBG or perform business-as-usual. The intervention and data collection lasts for a school year. Data will be collected at three time points: at baseline in the beginning of the school year (prior to training in GBG), after three months, and after nine months (at the end of the school year; primary endpoint). Data consists of teacher-rated measures of conduct problems, classroom climate, teacher collective efficacy, behavior management practices, and implementation factors, along with demographic factors. In addition, data will be collected by independent and blinded observers using corresponding measures in a subset of randomly chosen classrooms. Procedural fidelity will be rated and collected by GBG-trainers during nine observations throughout the school year. Statistical analysis will include frequentist intention-to-treat analysis, and comparisons of estimates with a corresponding Bayesian model using weakly informative priors. The study has currently completed data collection. This study will provide knowledge in universal prevention and school-based interventions with high reach, as well as specific knowledge concerning the effectiveness of an adapted version of GBG under real-world conditions, along with factors affecting its implementation and effects. ClinicalTrials.gov, identifier NCT05794893.

Consequences of daily self-weighing: a pilot study in higher-weight women with a history of breast cancer

Self-monitoring weight is commonly recommended for higher-weight women with a history of breast cancer, despite evidence demonstrating potentially negative psychological consequences of frequent self-weighing. The extent to which higher-weight women with breast cancer experience emotional and behavioral consequences in response to daily self-weighing is unknown. In this pilot study, women (n = 51) with a history of breast cancer in a behavioral weight management program completed a weeklong daily diary protocol. Participants were asked to self-weigh every morning and report on subsequent weight-related shame and guilt, and end-of-day engagement in compensatory exercise, diet, and purging behaviors. Women reported higher levels of guilt on days when their body weight was higher than usual, and when there was more discrepancy between their current vs. goal weight. Additionally, women engaged in higher levels of compensatory diet behavior on days when they experienced more weight-related guilt than usual. Based on these preliminary findings, daily self-weighing may be associated with harmful emotional and behavioral consequences among higher-weight women with a history of breast cancer.

Characterising individual variability in associations between self-monitoring and weight change during and after a behavioral weight management program.

Greater self-monitoring of caloric intake and weight has been associated with success at both initial weight loss and long-term maintenance. Given the existence of wide variability in weight loss outcomes and the key role of self-monitoring within behavioral weight management interventions, this study examined individual variability in associations between self-monitoring and weight change and whether demographic factors could predict who may best benefit from self-monitoring. Participants were 72 adults with overweight or obesity (mean±SD, age=50.6±10.3; body mass index=31.2±4.5kg/m2; 71%Female; 83%White) enrolled in a 12-week weight loss program followed by a 40-week observational maintenance period. Participants were encouraged to self-monitor caloric intake and weight daily and to report these data via a study website each week. Multilevel mixed models were used to estimate week-to-week associations between self-monitoring and weight change, by individual and linear regressions and ANOVAs were used to explore demographic differences in these associations. Most participants (68%) demonstrated statistically significant negative associations between self-monitoring of either caloric intake or weight and weight change. Of these, 76% benefited from self-monitoring both caloric intake and weight, 18% from self-monitoring caloric intake only, and 6% from self-weighing only. The magnitude of associations between self-monitoring and weight change did not significantly differ by age, gender, race/ethnicity, education, or income, all ps>0.05. Differences in the effectiveness of self-monitoring for weight loss were not observed by demographic characteristics. Future research should examine if other factors may predict the effectiveness of self-monitoring.