Evidence-based Weight Loss Program Research Articles

Pilot evaluation of a behavioral weight loss program for adults with physical disabilities: State of Slim Everybody usability and feasibility.

People with physical disabilities (PWD) have a higher prevalence of obesity than populations without disability, but most evidence-based weight loss programs have not included this population. The State of Slim (SOS) program is an evidence-based weight loss program that has demonstrated success in producing weight loss in populations without disability, but it has not been adapted for or evaluated in PWD. The SOS program was systematically adapted using the evidence-informed Guidelines, Recommendations, and Adaptations Including Disability (GRAIDs) framework. A total of 35 participants enrolled in the State of Slim Everybody program. The program was offered entirely online. Body weight, attendance, and food log completion were also tracked weekly. The program length was 16.5h and included weekly group instruction, with optional one-on-one sessions provided upon request. Following completion, participants completed post-evaluation surveys on overall satisfaction with the program. The primary outcomes were program effectiveness (i.e., body weight), usability, and feasibility. Thirty-two out of 35 participants completed the program, representing a retention rate of 91.4%. Average weight loss was 10.9% (9.9±0.7kg (t (31)=-13.3, p =< 0.0001)). On a 1 (dissatisfied/completely useless) to 5 (very satisfied/completely helpful) Likert scale, the average score for overall program satisfaction was 4.8±0.1 and program helpfulness 4.6±0.1. The State of Slim Everybody program demonstrated significant weight loss and good usability and feasibility in PWD. Existing adaptation frameworks can be used to create inclusive health promotion programs for adults with physical disabilities.

Accessible weight loss program for adults who are legally blind: A pilot study

BackgroundCompared to those without vision impairments, adults with low vision have higher rates of obesity and face more barriers to participation in traditional weight loss programs. ObjectiveThis pilot study examined the usability and helpfulness of an adaptive, evidence-based weight loss program for adults who are legally blind. MethodsThe study was a remotely delivered, single-arm weight loss trial for adults who were legally blind with a body mass index (BMI) ≥ 25. At weeks 4 and 8, participants reported usability and helpfulness of program components using a five-point scale (0–4) with higher numbers indicating greater usability and helpfulness. Weight data were collected at baseline, week 4, and week 8 using a scale with cellular technology. The adaptive 8-week weight loss program included evidence-based lifestyle recommendations for diet, physical activity, and self-weighing. The program provided support through text messages, emails, and video-based problem-solving sessions. ResultsParticipants (N = 28) were aged 53.4 ± 10.2 years, 89.3% female, 35.7% Black, and 57.1% non-Hispanic White with an average BMI of 35.4 ± 8.8 kg/m2. Most program components had a median score of 4 for usability and helpfulness except educational materials (helpfulness, median 3). Compared to baseline weight, participants had a weight loss of 2.2 ± 2.1% (p < .001) at week 4 and 3.6 ± 3.0% (p < .001) at week 8. ConclusionsThis study has provided evidence that an all-remote weight loss program can be a useable, helpful, and effective approach for adults who are legally blind. More work is needed to develop scalable, sustainable, and fully accessible evidence-based weight loss programs. Trial registrationClinicaltrials. gov identifier: NCT05419063.

Self-Monitoring Physical Activity, Diet, and Weight Among Adults Who Are Legally Blind: Exploratory Investigation.

Obesity is a global pandemic. Lifestyle approaches have been shown effective for weight loss and weight loss maintenance. Central to these evidence-based approaches are increased physical activity, decreased caloric intake, regular self-weighing, and the tracking of these behaviors. This exploratory descriptive study surveyed adults who are legally blind to identify strategies related to tracking physical activity, diet, and weight. These health behaviors are essential components to evidence-based weight loss programs. We also identified areas where we can better support adults who are legally blind in their independent efforts to change these behaviors and improve their health. Participants (≥18 years of age) who self-identified as being legally blind were recruited using email announcements in low vision advocacy groups. They completed an interviewer-administered survey on the telephone and an in-person visit for standardized assessment of height and weight. The participants (N=18) had an average age of 31.2 (SD 13.4) years; 50% (9/18) had normal weight (BMI 18.5 to <25); 44% (8/18) were female; 44% (8/18) were Black; and 39% (7/18) were Non-Hispanic White. Most participants (16/18, 89%) used their smartphone to access the internet daily, and 67% (12/18) had at least 150 mins of exercise per week. Although 78% (14/18) of the participants indicated tracking their weight, only 61% (11/18) could indicate how they tracked their weight, and 22% (4/18) indicated they tracked it mentally. Providing individuals with a talking scale was the most consistent recommendation (12/18, 67%) to facilitate independence in managing weight through lifestyle changes. Even though 50% (9/18) of the participants indicated using an app or electronic notes to track some portion of their diet, participants reported challenges with determining portion size and corresponding calorie counts. Most participants (17/18, 94%) reported using apps, electronic notes, smartphones, or wearable devices to track their physical activity. Although strategies such as using wearables and smartphones could provide measurements (eg, step counts) as well as recording data, they also pose financial and technology literacy barriers. Technology-based solutions were identified for tracking weight, diet, and physical activity for weight management. These strategies have financial and technology literacy barriers. A range of strategies for adopting and tracking health behaviors will be needed to assist individuals with varying skills and life experiences.

Better Together: Evolution of Patient Stakeholder Engagement in Healthy Lifestyle Research After Acquired Brain Injury

<h3>Research Objectives</h3> To describe the process of partnering with stakeholders in a six-year systematic line of research to modify an evidence-based weight-loss program called the Diabetes Prevention Program Group Lifestyle Balance (DPP-GLB) for individuals with individuals with TBI and stroke. Commentary from two patient stakeholders will be included. <h3>Design</h3> Narrative Review. <h3>Setting</h3> Community. <h3>Participants</h3> Stakeholders (former patients, care partners, physiatrists, researchers, therapists, neuropsychologists, exercise specialists, dietitians, community partners, and DPP-GLB coaches). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Not applicable. <h3>Results</h3> The DPP-GLB modification process involved three phases: (1) engaging stakeholders to identify appropriate adaptations to the DPP-GLB, (2) making relevant modifications to create the GLB-CVA and GLB-TBI, and (3) obtaining approval from the stakeholders that modifications accurately reflect their recommendations. Engagement was sustained through (1) piloting research surveys, (2) providing guidance on eligibility criteria and outcome assessments, (3) testing mobile applications, (4) reviewing factsheets for usability, (5) attending quarterly meetings, and (6) informing future grant applications. <h3>Conclusions</h3> Stakeholder perspectives have been critically important to ensuring study goals and project activities are meaningful and patient-centered. Our stakeholders helped create a more health literate (e.g., factsheets, modified curriculum), patient-centered (e.g., including peer mentors and care partners), and meaningful program for people with TBI and stroke, which would not have been possible with our research team alone. <h3>Author(s) Disclosures</h3> he contents of this abstract were developed under two grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DPTB0013 and 90IFRE0021). NIDILRR is a center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this abstract do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

A 2.5-Year Weight Management Program Using Noom Health: Protocol for a Randomized Controlled Trial.

BackgroundOverweight and obesity are serious public health concerns. As the prevalence of excess weight among individuals continues to increase, there is a parallel need for inexpensive, highly accessible, and evidence-based weight loss programs.ObjectiveThis weight loss trial will aim to examine the efficacy of the Noom weight loss program in comparison to a digital control after a 6-month intervention phase and a 24-month maintenance phase, with assessments continuing for 2 years beyond the intervention (to 30 months—after the baseline). The secondary outcomes include quality of life, psychosocial functioning, sleep quality, physical activity, diet, and health status. This trial will also examine the severity of obesity-related functional impairment, weight loss history, and demographic moderators, along with adherence and self-efficacy as mediators of the outcome.MethodsA total of 600 participants were randomized in a parallel-group, controlled trial to either Noom Healthy Weight Program (intervention) or Noom Healthy Weight Control (control) for a 6-month intervention. Both intervention and control groups include diet and exercise recommendations, educational content, daily logging capabilities, and daily weigh-in entries. The Noom Healthy Weight Program also includes a coach support for weight loss. Remote follow-up assessments of eating, physical activity, psychosocial factors, app use data, and weight will be conducted at 1, 4, 6, 12, 18, 24, and 30 months after baseline. Weight is measured at each follow-up point during a Zoom call using the participants’ scales.ResultsEnrollment began in March 2021 and the 6-month intervention phase ended in March 2022. Data collection for the final assessment will be completed in March 2024.ConclusionsThis study tests commercially available digital lifestyle interventions for individuals with overweight and obesity seeking weight loss support. Data obtained from the study will evaluate whether the Noom Healthy Weight Control Program can help individuals overcome weight loss, achieve long-term maintenance, adhere to lifestyle changes, and feature use barriers that are present in other traditional weight loss treatments.Trial RegistrationClinicalTrials.gov NCT04797169; https://clinicaltrials.gov/ct2/show/NCT04797169International Registered Report Identifier (IRRID)DERR1-10.2196/37541

Impact of a self-guided, eHealth program targeting weight loss and depression in men: A randomized trial.

Objective: Obesity and depression are major, inter-related health concerns for men, yet many do not receive support to manage these conditions. This study investigated whether a self-guided, eHealth program (SHED-IT: Recharge) could reduce weight and depressive symptoms in men with overweight or obesity and low mood. Method: Overall, 125 men [Body Mass Index (BMI) 25-42 kg/m2] with depressive symptoms [Patient Health Questionnaire-9 (PHQ-9) score ≥5] were recruited for a 6-month RCT. Men were randomized to (a) the SHED-IT: Recharge group (n = 62) or (b) a wait-list control group (n = 63). The 3-month program included printed and online resources (e.g., website, interactive modules). It was adapted from an evidence-based weight loss program for men to include an additional focus on "mental fitness". The primary outcomes were weight (kg) and depressive symptoms (PHQ-9) at 3 months. Men were assessed at baseline, 3 months (post-intervention), and 6 months. Intention-to-treat linear mixed models examined program outcomes. Results: At 3 months, medium-sized treatment effects were detected for both weight, adjusted mean difference -3.1 kg, 95% CI [-4.3, -1.9], d = 0.9, and depressive symptoms, adjusted mean difference -2.4 units, 95% CI [-4.0, -0.9], d = 0.6. These effects were maintained at 6 months and supported by sustained improvements in other health outcomes. Conclusions: A self-guided, eHealth program that combined behavioral weight loss advice with mental health support decreased weight and depressive symptoms in men. Integrated interventions targeting physical and mental health may be an effective strategy to engage and support men with overweight or obesity and low mood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sustaining the reach of a scalable weight loss intervention through financial incentives- a pragmatic, feasibility, online randomized trial protocol

BackgroundHigh attrition following initial enrollment in evidence-based weight loss programs is a common, challenging, and under-studied issue. A behavioral economics approach consisting of modest monetary incentives may help to engage participants beyond enrollment to close the initial attrition gap. PurposeTo describe the methods and design of a pragmatic, online randomized controlled trial (RCT) of an incentivized, technology-facilitated weight loss program through an innovative research-practice partnership involving primary care, health promotion researchers, and a small business. MethodsThis study is a four-arm (1:1:1:1) RCT that compares the efficacy of outcome-based (weight loss), process-based (weighing in), a combination of outcome- and process-based, or choice-based incentives on sustaining program reach after initial enrollment for an evidence-based weight loss program. The multicomponent weight loss program includes a website, social cognitive theory-based daily health coaching, tailored messaging delivered via email and text messaging, access to online health coaches, and objective weight assessment through a community kiosk. The study will enroll 400 individuals aged 19 and older who have a body mass index ≥25 kg/m2, and have reliable access to the Internet or a smart phone. Participants will be followed for 3, 6, 9, and 12 months to assess program reach and representativeness, and continued participation after enrollment. The secondary outcomes include weight loss and program implementation costs. We will conduct participant focus groups to understand the barriers and facilitators of participation and key informant interviews focusing on clinic managers and care providers to explore the potential for future adoption and implementation of the evidence-based program. DiscussionThis study possesses the potential to close the attrition gap after initial enrollment in a web-based digital weight loss intervention in the primary care and community settings. Clinicaltrials.gov registration: NCT04225234.

Abstract B010: Avanzando juntas: Adapting an evidence-based weight loss program for Hispanic breast and gynecologic cancer survivors

Abstract Background: Obesity increases risk for recurrence for many cancers. Hispanic breast and gynecological cancer survivors (BGCS) are more likely than Non-Hispanic White BGCS to have overweight/obesity. Weight management is challenging for many Hispanics due to a complex interaction of environmental, societal and policy-related factors. These factors also contribute to disparities in cancer recurrence risk, quality of life and comorbidities. This study informed the adaptation of the evidence-based Moving Forward weight loss intervention for Hispanic BGCS. Methods: Intervention adaptation was done in an iterative process with continuous engagement of BGCS and a community advisory committee. Hispanic BGCS with BMIs &amp;lt; 25 kg/m2 who had completed treatment at least 3 months prior were invited to participate in two focus groups offered in Spanish or English. Focus group I informed initial adaptations asking general questions about lifestyle support, interests and needs, family and community attitudes about weight and breast cancer. Focus group II was structured with participants reviewing intervention topics and materials to inform program refinement. All groups were audio-recorded and transcribed. Multi-faceted content analysis used a combination of inductive and deductive approaches, leading to codes which were then compiled into overarching themes. Results: 30 HBGCS participated in the first round of data collection. We conducted 4 focus groups (3 English, 1 Spanish) with 14 survivors. The other 18 HBGCS completed individual interviews, an approach found to be more accessible to these predominately Spanish-speaking women. For Focus Group II, 24 of the same 30 women participated. The majority completed a focus group and 8 completed interviews. Content analysis revealed 3 major themes related to survivorship, needs and wants in the intervention: Relationships and Support, Wellness, and Advocacy and Empowerment. A cross-cutting theme underlying all topics was acculturation. Focus Group II provided additional details including particular foods and cooking methods, beliefs and values, holidays, community assets and needs, and family roles and responsibilities. These data informed intervention adaptations. Conclusions: Level of acculturation was a defining factor for participants’ relationship and support dynamics, access to wellness resources, and self-advocacy versus relying on others to advocate for them. Next steps are to pilot the adapted program, Avanzando Juntas. Outcomes will include weight, metabolic syndrome risk factors and cancer recurrence biomarkers. Citation Format: AnaKaren Manriquez Prado, BA, Stacy Young, PhD, Sailaja Kamaraju, MD, Magdalisse Henderson, MS, Patricia Sheean, PhD, Melinda Stolley, PhD. Avanzando juntas: Adapting an evidence-based weight loss program for Hispanic breast and gynecologic cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B010.

Weight Loss After Stroke Through an Intensive Lifestyle Intervention (Group Lifestyle Balance-Cerebrovascular Accident): Protocol for a Randomized Controlled Trial.

BackgroundWeight gain can be a consequence of stroke, or cerebrovascular accident (CVA), because of impaired mobility, behavioral and emotional disorders, and sensory losses. Weight gain increases the patient’s risk of recurrent stroke and chronic diseases, such as diabetes, metabolic syndrome, and pulmonary and heart disease. Approaches to weight loss in this population are lacking, although necessary because of the unique physiological and cognitive needs of persons after a stroke. Evidence shows that intensive behavioral therapy interventions that address both physical activity and diet offer the greatest potential for weight loss. The Group Lifestyle Balance (GLB) intervention is a 12-month, evidence-based weight loss program that has been used extensively with the general population; this program was modified to meet the needs of people who have had a stroke (GLB-CVA).ObjectiveThis randomized controlled trial (RCT) aims to examine the efficacy of the GLB-CVA on weight and secondary outcomes, compared with that of a waitlist control group.MethodsThis RCT will enroll and randomize 64 patients over an 18-month period.ResultsCurrently, 51 people are waitlisted, with 23 out of 51 screened and 16 out of 23 eligible.ConclusionsIt is anticipated that the findings from this RCT will contribute to the evidence base regarding weight loss strategies for people living with stroke.Clinical TrialClinicalTrials.gov NCT03873467; https://clinicaltrials.gov/ct2/show/NCT03873467

A randomized controlled trial protocol for people with traumatic brain injury enrolled in a healthy lifestyle program (GLB-TBI).

Weight gain is prevalent among people with traumatic brain injury (TBI) and may be attributable to environmental or injury-specific factors such as mobility impairment, endocrine dysfunction, behavioral and emotional disorders, and sensory loss. Few weight management programs exist to meet the unique needs of this population. Researchers modified a nationally recognized, evidence-based weight-loss program, Group Lifestyle Balance™ (GLB), to address the needs of over-weight and obese people post TBI (GLB-TBI). This current randomized controlled trial (RCT) examines the efficacy of the GLB-TBI on weight and secondary outcomes compared to an attention control educational support group. Furthermore, researchers have developed a mobile technology app to further engage participants in the program. This RCT will enroll and randomize 66 participants over a two-year period. It is anticipated that findings from this current RCT will contribute to the knowledge and evidence for an effective weight-loss intervention among this underserved population, with a goal of achieving full recognition by the Centers for Disease Control and Prevention-National Diabetes Prevention Program and subsequent Center for Medicare and Medicaid Services reimbursement for participation.

Health Care Provider Counseling for Weight Loss Among Adults with Arthritis and Overweight or Obesity - United States, 2002-2014.

In the United States, 54.4 million adults report having doctor-diagnosed arthritis (1). Among adults with arthritis, 32.7% and 38.1% also have overweight and obesity, respectively (1), with obesity being more prevalent among persons with arthritis than among those who do not have arthritis (2). Furthermore, severe joint pain among adults with arthritis in 2014 was reported by 23.5% of adults with overweight and 31.7% of adults with obesity (3). The American College of Rheumatology recommends weight loss for adults with hip or knee osteoarthritis and overweight or obesity,* which can improve function and mobility while reducing pain and disability (4,5). The Healthy People 2020 target for health care provider (hereafter provider) counseling for weight loss among persons with arthritis and overweight or obesity is 45.3%.† Adults with overweight or obesity who receive weight-loss counseling from a provider are approximately four times more likely to attempt to lose weight than are those who do not receive counseling (6). To estimate changes in the prevalence of provider counseling for weight loss reported by adults with arthritis and overweight or obesity, CDC analyzed National Health Interview Survey (NHIS) data.§ Overall, age-standardized estimates of provider counseling for weight loss increased by 10.4 percentage points from 2002 (35.1%; 95% confidence interval [CI]=33.0-37.3) to 2014 (45.5%; 95% CI=42.9-48.1) (p<0.001). Providing comprehensive behavioral counseling (including nutrition, physical activity, and self-management education) and encouraging evidence-based weight-loss program participation can result in enhanced health benefits for this population.

Preferences and motivation for weight loss among knee replacement patients: implications for a patient-centered weight loss intervention

BackgroundMost knee replacement patients are overweight/obese, yet are commonly excluded from evidence-based weight loss programs due to mobility limitations and barriers faced around the time of surgery. The purpose of this study was to identify knee replacement patient preferences for weight loss programs and qualitatively understand previous motives for weight loss attempts as well as strategies used to facilitate behavior changes.MethodsPatients who were either scheduled to have knee replacement or had one recently completed within the last 3 months were recruited to participate. Patients completed a brief weight loss program preference questionnaire assessing preferred components of a weight loss program (i.e. self-monitoring, educational topics, program duration). Qualitative interviews were completed to identify motives for and strategies used during past weight loss attempts. All interviews were transcribed, de-identified, and analyzed using constant comparative analysis.ResultsTwenty patients (11 pre-operative and 9 post-operative) between 47 and 79 years completed the study (55% male, 90% White, and 85% with a BMI ≥25 kg/m2). Patients reported a preference for a weight loss program that starts before surgery, is at least 6 months in duration, and focuses both on diet and exercise. The majority of patients preferred to have a telephone-based program and wanted to track diet and physical activity on a smartphone application. The most common motive for weight loss mentioned by patients related to physical appearance (including how clothing fit), followed by wanting to lose weight to improve knee symptoms or to prevent or delay knee replacement. Strategies that patients identified as helpful during weight loss attempts included joining a formal weight loss program, watching portion sizes, and self-monitoring their dietary intake, physical activity, or weight.ConclusionsThis study provides a preliminary examination into the motives for weight loss, strategies utilized during past weight loss attempts, and preferences for future weight loss programs as described by knee replacement patients. These results will help guide the development and adaptation of future patient-centered weight loss programs as well as help clinicians recommend targeted weight programs based on the specific preferences of the knee replacement population.

Applying economic incentives to increase effectiveness of an outpatient weight loss program (TRIO) – A randomized controlled trial

The prevalence of overweight and obesity has more than doubled in the past three decades, leading to rising rates of non-communicable diseases. This study tests whether adding a payment/rewards (term reward) program to an existing evidence-based weight loss program can increase weight loss and weight loss maintenance. We conducted a parallel-group randomized controlled trial from October 2012 to October 2015 with 161 overweight or obese individuals randomized to either control or reward arm in a 1:2 ratio. Control and reward arm participants received a four month weight loss program at the LIFE (Lifestyle Improvement and Fitness Enhancement) Centre at Singapore General Hospital. Those in the reward arm paid a fee of S$165.00 (1US$ = 1.35S$) to access a program that provided rewards of up to S$660 for meeting weight loss and physical activity goals. Participants could choose to receive rewards as guaranteed cash payments or a lottery ticket with a 1 in 10 chance of winning but with the same expected value. The primary outcome was weight loss at months 4, 8, and 12. 161 participants were randomized to control (n = 54) or reward (n = 107) arms. Average weight loss was more than twice as great in the reward arm compared to the control arm at month 4 when the program concluded (3.4 kg vs 1.4 kg, p < 0.01), month 8 when rewards concluded (3.3 kg vs 1.8 kg, p < 0.05), and at month 12 (2.3 kg vs 0.8 kg, p < 0.05). These results reveal that a payment/rewards program can be used to improve weight loss and weight loss maintenance when combined with an evidence-based weight loss program. Future efforts should attempt to replicate this approach and identify how to cost effectively expand these programs to maximize their reach. This study is registered at www.clinicaltrials.gov (Identifier: NCT01533454).

Persistent weight loss with a non-invasive novel medical device to change eating behaviour in obese individuals with high-risk cardiovascular risk profile.

In evidence-based weight-loss programs weight regain is common after an initial weight reduction. Eating slowly significantly lowers meal energy intake and hunger ratings. Despite this knowledge, obese individuals do not implement this behaviour. We, thus tested the hypothesis of changing eating behaviour with an intra-oral medical device leading to constant weight reduction in overweight and obesity.Six obese patients (6 men, age 56 ± 14, BMI 29 ± 2 kg / m2) with increased CVRF profile were included in this prospective study. All patients had been treated for obesity during the last 10 years in a single centre and had at least 3 frustrate evidence-based diets. Patients received a novel non-invasive intra-oral medical device to slow eating time. Further advice included not to count calories, to avoid any other form of diet, to take their time with their meals, and to eat whatever they liked.This device was used only during meals for the first 4 to 8 weeks for a total of 88 [20–160] hours. Follow-up period was 23 [15–38] months. During this period, patients lost 11% [5–20%] (p<0.001) of their initial weight. At 12 months, all patients had lost >5%, and 67% (4/6) achieved a >10% bodyweight loss. In the course of the study, altered eating patterns were observed. There were no complications with the medical device. Of note, all patients continued to lose weight after the initial intervention period (p<0.001) and none of them had weight regain.With this medical device, overweight and obese patients with a history of previously frustrating attempts to lose weight achieved a significant and sustained weight loss over two years. These results warrant the ongoing prospective randomised controlled trial to prove concept and mechanism of action.Trial registration: German Clinical Trials Register DRKS00011357

Accessible weight loss: Adapting a lifestyle intervention for adults with impaired mobility

BackgroundDespite disparities in obesity between those with and without disability, there is limited evidence to guide weight loss intervention in people with impaired mobility (IM), particularly those with severe impairments. ObjectiveExamine the usability, feasibility, and effectiveness of adapting an existing evidence-based weight loss program for people with IM. MethodsIn this single-group pre-test post-test pilot study, 10 overweight or obese individuals with permanent IM (e.g. spinal cord injury, spina bifida, osteoarthritis) participated in a 20-week modification of the DPP Group Lifestyle Balance™ (DPP GLB) program, a group-based adaptation of the Diabetes Prevention Program (DPP). Fifteen conference calls encouraged reducing calorie and fat intake and increasing exercise through self-monitoring and problem solving. We defined feasibility as retention and engagement, usability as participants' program satisfaction ratings, and effectiveness as physiological and psychosocial change measured on three occasions over 20 weeks. Analytic methods included basic descriptive statistics (feasibility and usability) and repeated measures ANOVA (effectiveness). ResultsThe program retained 70% of participants. These individuals attended an average of 79.3% of conference calls and self-monitored more than half of the weeks. Participants rated the program highly, with mean overall scores of 6.3 ± 0.3 and 6.2 ± 0.6 out of 7 on helpfulness and satisfaction scales, respectively. Program completers experienced a significant mean weight loss of 8.86 ± 8.37 kg (p = 0.024), or 7.4% of their start weight, and significantly reduced their BMI. ConclusionsAn adapted version of the DPP GLB is a feasible, usable, and potentially effective intervention for promoting weight loss among persons with IM.

Evidence-Based Strategies in Weight-Loss Mobile Apps

Physicians have limited time for weight-loss counseling, and there is a lack of resources to which they can refer patients for assistance with weight loss. Weight-loss mobile applications (apps) have the potential to be a helpful tool, but the extent to which they include the behavioral strategies included in evidence-based interventions is unknown. The primary aims of the study were to determine the degree to which commercial weight-loss mobile apps include the behavioral strategies included in evidence-based weight-loss interventions, and to identify features that enhance behavioral strategies via technology. Thirty weight-loss mobile apps, available on iPhone and/or Android platforms, were coded for whether they included any of 20 behavioral strategies derived from an evidence-based weight-loss program (i.e., Diabetes Prevention Program). Data on available apps were collected in January 2012; data were analyzed in June 2012. The apps included on average 18.83% (SD=13.24; range=0%-65%) of the 20 strategies. Seven of the strategies were not found in any app. The most common technology-enhanced features were barcode scanners (56.7%) and a social network (46.7%). Weight-loss mobile apps typically included only a minority of the behavioral strategies found in evidence-based weight-loss interventions. Behavioral strategies that help improve motivation, reduce stress, and assist with problem solving were missing across apps. Inclusion of additional strategies could make apps more helpful to users who have motivational challenges.

Lay Health Educators Translate a Weight-Loss Intervention in Senior Centers: A Randomized Controlled Trial

Older adults have high obesity rates and respond well to evidence-based weight-loss programs, such as the Diabetes Prevention Program (DPP) Lifestyle intervention. The goal of this study was to determine whether a translation of the DPP Lifestyle program delivered by lay health educators and conducted in senior centers is effective in promoting weight loss among older adults.An RCT with older adults nested within senior centers. Senior centers identified lay health educators to receive training and deliver the intervention program at the senior center. Senior centers were randomized to DPP Lifestyle program or an attention control intervention (cognitive training).Senior centers (N=15) located throughout Arkansas. Participants (N=228) were obese (BMI=34.5±4.9) older (aged 71.2±6.6 years) adults able to engage in moderate exercise. Follow-up data were collected at 4 months on 93% of the original cohort between February 2009 and July 2010.A 12-session translation of the Diabetes Prevention Program Lifestyle behavioral weight-control program delivered in group sessions by trained lay health educators.Body weight was assessed by digital scale. Percentage weight loss from baseline and proportion achieving ≥5% and ≥7% weight loss were examined. Analyses were completed in March 2011.Participants attending senior centers randomized to Lifestyle lost a significantly greater percentage of baseline weight (3.8%, 95% CI=2.9%, 4.6%) than those in the control senior centers (0.2%, 95% CI= -0.6%, -0.9%) after adjusting for baseline BMI and gender (p<0.001). Among participants attending senior centers offering the Lifestyle program, 38% lost ≥5% of baseline weight compared with 5% in the control arm (p<0.001). Similarly, significantly more participants (24%) in Lifestyle senior centers lost ≥7% than did control participants (3%, p=0.001).A behavioral lifestyle weight-loss intervention delivered by a lay health educator offers a promising vehicle for translation of evidence-based obesity treatment programs in underserved areas.This study is registered at Clinicaltrials.govNCT01377506.