Group Lifestyle Balance Research Articles

Study protocol of a pragmatic randomized controlled trial incorporated into the Group Lifestyle Balance\u2122 program: the nutrigenomics, overweight/obesity and weight management trial (the NOW trial)

BackgroundThe nutrigenomics, overweight/obesity and weight management trial (NOW Trial) is a pragmatic randomized controlled trial of community-dwelling adults recruited from the Group Lifestyle Balance™ (GLB™) Program. The GLB™ Program (formerly referred to as the Diabetes Prevention Program) is an evidence-based, intensive weight management program, which was offered to overweight/obese patients (BMI ≥ 25.0 kg/m2) in a rural Ontario community.MethodsPatients enrolled in the GLB™ Program were invited to participate in this study. GLB™ groups were randomized 1:1 to receive either the standard GLB™ program + population-based lifestyle advice for weight management, or a modified GLB™ program + personalized, genetic-based lifestyle advice for weight management. The purpose of this study is to determine if the provision of genetic-based lifestyle guidelines is superior to the provision of population-based guidelines in a pragmatic clinical setting to promote changes in: body composition, weight, body mass index, dietary and physical activity habits, as well as attitudes, subjective norms, and behavioural control. The 12-month intervention protocol consists of 23 group-based sessions and 4 one-on-one sessions. Data collection time points include baseline in addition to 3, 6, and 12-month follow up. The comprehensive study design is described in the present manuscript, using both the extended CONSORT checklist for reporting pragmatic trials and the SPIRIT checklist as guidance during manuscript development.DiscussionOverall, this study seeks to pragmatically determine if the provision of DNA-based lifestyle advice leads to improved health and lifestyle outcomes compared to the provision of standard, population-based lifestyle advice. The results of this trial can be used to inform clinical and community nutrition practice guidelines.Trial registrationThis study was registered with clinicaltrials.gov: NCT03015012 on January 9, 2017.

Impact of a Community-Based Healthy Lifestyle Program on Individuals With Traumatic Brain Injury.

To examine adherence with and effect of an evidence-based healthy lifestyle intervention modified for individuals with traumatic brain injury (TBI). Pre-/postintervention without control. Community. Eighteen individuals with TBI: primarily male (61%), white (67%), with private insurance (50%). Mean age was 45.6 ± 12.3 years, weight 210 ± 42.6 lb, and body mass index 31.8 ± 4.6 (obese category) at baseline. The primary goal of the Diabetes Prevention Program Group Lifestyle Balance program is 5% to 7% weight loss through increased physical activity and improved dietary behaviors. Adherence (ie, session attendance and self-monitoring of dietary behaviors), physiologic changes (ie, weight loss, blood pressure; waist and arm circumference; and lipid profile), and quality of life (ie, self-reported health, quality of life, and step count). Average participant attendance (85% over 12 months) and self-monitoring (90% over 6 months) were high. Significant decreases were observed in diastolic blood pressure and waist and arm circumference from baseline through 12 months and from baseline to 3 months only for weight and total cholesterol. No significant changes were observed in self-reported health, quality of life, or step count. Participants demonstrated high adherence with the program, suggesting that individuals with TBI are able to successfully engage in the program and achieve significant weight loss and changes in key physiologic outcomes.

Developing mHealth Tools to Enhance Engagement in a Behavioral Lifestyle Intervention After Traumatic Brain Injury

To develop mHealth apps to enhance participation of people with Traumatic Brain Injury (TBI) in the Group Lifestyle Balance (GLB) weight loss intervention.

Usability of the Group Lifestyle Balance Program – Adapted for individuals with Impaired Mobility (GLB-AIM)

To evaluate participants’ assessment of usability.

Evaluation of a Diabetes Prevention Program Lifestyle Intervention in Older Adults: A Randomized Controlled Study in Three Senior/Community Centers of Varying Socioeconomic Status

Purpose The purpose of this study is to evaluate the feasibility and effectiveness of an adapted Diabetes Prevention Program (DPP) lifestyle program, DPP Group Lifestyle Balance (GLB), delivered in 3 economically diverse senior/community centers. Methods The DPP-GLB was implemented in 3 senior/community centers in Allegheny County, PA. A 6-month delayed control intervention design was used. Participants were randomized to begin the DPP-GLB immediately (immediate) or after a 6-month delay (delayed). Adults (n = 134; mean age = 62.8 years) with BMI ≥24 kg/m2 and prediabetes and/or the metabolic syndrome took part. Weight, physical activity (PA), and diabetes and cardiovascular disease (CVD) risk factors were assessed at 6, 12, and 18 months from baseline. Results At 6 months, the immediate group demonstrated greater mean weight loss than the delayed control group as well as significantly greater improvements in PA, A1C, fasting insulin, and waist circumference. In pre-post analyses, both randomized groups showed similar success that was maintained at 18 months. Conclusions The DPP-GLB delivered in economically diverse community centers was effective in this group of older adults. These findings support provision of coverage for prevention programs in older adults at risk for diabetes/CVD, which is important considering the large number of individuals who will be Medicare eligible in the near future.

Translational study of obesity management using the Diabetes Prevention Program "Group Lifestyle Balance" in primary care clinics and public hospitals from Mexico: study protocol

Introduction: Obesity is the main modifiable risk factor for the development of chronic diseases in Mexico. Several randomized controlled trials have shown that intensive lifestyle programs are efficacious for the management of obesity. These programs include frequent sessions (14 or more contacts in the first 6 months) focused on diet and physical activity and use a behavior change protocol. However, most Mexican primary care clinics and public hospitals apply traditional treatments for obesity management with limited results on weight loss. The purpose of the study is to evaluate the effectiveness of the Diabetes Prevention Program (DPP) “Group Lifestyle Balance” for weight loss among adults with overweight and obesity from baseline to 6 months and from baseline to 12 months in primary care clinics and public hospitals from Sonora, Mexico.Material and Methods: This is a translational, multi-center, non-controlled, 6 and 12-month follow-up clinical study with a pre-test and post-test design. Healthcare providers from two primary care clinics, two hospitals and one university clinic will be trained with the DPP protocol to implement on their patients with overweight and obesity. Body weight, body mass index, waist circumference, systolic and diastolic blood pressure, depression, quality of life and stress scales will be measured in participants receiving the program at baseline, 6 and 12 months. Biochemical parameters will be measured at baseline and 12 months. The primary outcome is the change in body weight at 6 and 12 months.Discussion: This study will provide scientific evidence of the effectiveness of the DPP protocol as a model for obesity management in real world clinical practice among the adult Mexican population.

Evaluation of the Group Lifestyle Balance Program in a Military Setting: An Investment Worth Expanding.

The Diabetes Prevention Program (DPP) demonstrated that lifestyle intervention programs were effective in preventing or delaying the onset of diabetes. The Group Lifestyle Balance (GLB) program translated the DPP curriculum into a 12-wk group intervention for those at risk for diabetes. This retrospective evaluation examined clinical outcomes for patients in the Diabetes Center of Excellence GLB program located at Wilford Hall Ambulatory Surgical Center from 2009 to 2013. Objectives included determining rates of retention, demographic characteristics of program completers, and changes in metabolic surrogates of disease prevalence. Adults with prediabetes or metabolic syndrome (MetS) were referred to the GLB program. Updated participant metabolic data were collected at regular intervals during their participation. During the 5-yr study, 704 patients attended the initial class. Overall, 52% of all participants completed the program with the greatest decline in participation occurring by the fourth week (30%). Baseline prevalence of conditions of interest for those who completed the program was prediabetes (93.2%), obesity (56.1%), and MetS (31.5%). GLB completers were older and retired (p < 0.05). A significant number of active duty military members (44.9%, p < 0.01, n = 53) dropped out of the program before the fourth week. Furthermore, those who completed the program saw a 2.0% reduction in prediabetes prevalence (p < 0.001), obesity decreased by 8.7% (p < 0.001), and MetS decreased by 6.8% (p < 0.01). Significant differences were found for central obesity, triglycerides, and fasting blood sugar (p < 0.001). The GLB program is a valuable DPP and was effective at improving clinical outcomes and reducing the incidence of prediabetes, obesity, and MetS for participants who completed the program. Every effort should be made to support and encourage GLB participants to complete the program.

Reducing barriers to healthy weight: Planned and responsive adaptations to a lifestyle intervention to serve people with impaired mobility

BackgroundPeople with impaired mobility (IM) disabilities have a higher prevalence of obesity and obesity-related chronic conditions; however, lifestyle interventions that address the unique needs of people with IM are lacking. ObjectiveThis paper describes an adapted evidence-based lifestyle intervention developed through community-based participatory research (CBPR). MethodsIndividuals with IM, health professionals, disability group representatives, and researchers formed an advisory board to guide the process of thoroughly adapting the Diabetes Prevention Program Group Lifestyle Balance (DPP GLB) intervention after a successful pilot in people with IM. The process involved two phases: 1) planned adaptations to DPP GLB content and delivery, and 2) responsive adaptations to address issues that emerged during intervention delivery. ResultsPlanned adaptations included combining in-person sessions with conference calls, providing arm-based activity trackers, and adding content on adaptive cooking, adaptive physical activity, injury prevention, unique health considerations, self-advocacy, and caregiver support. During the intervention, participants encountered numerous barriers, including health and mental health issues, transportation, caregivers, employment, adjusting to disability, and functional limitations. We addressed barriers with responsive adaptations, such as supporting electronic self-monitoring, offering make up sessions, and adding content and activities on goal setting, problem solving, planning, peer support, reflection, and motivation. ConclusionsGiven the lack of evidence on lifestyle change in people with disabilities, it is critical to involve the community in intervention planning and respond to real-time barriers as participants engage in change. A randomized controlled trial (RCT) is underway to examine the usability, feasibility, and preliminary effectiveness of the adapted intervention.

Modifying an evidence-based lifestyle programme for individuals with traumatic brain injury

ABSTRACTObjective: Individuals with traumatic brain injury (TBI) are at a risk of obesity-related chronic diseases; yet, no evidence-based strategies exist to support weight management in this population. The purpose of this study was to use participatory action research to modify the Diabetes Prevention Program Group Lifestyle Balance (DPP-GLB) programme for overweight/obese people with TBI. The DPP-GLB programme provides education and self-management skills for individuals to reach their lifestyle goals through healthy eating and physical activity. Methods: A committee of 10 stakeholders including clinicians, patients and caregivers reviewed and modified the DPP-GLB for overweight/obese individuals with TBI. Stakeholders suggested modifications to the content, layout, format, language, behaviour-changing strategies and delivery approaches. The group also provided input on research applications of the modified DPP-GLB including recruitment strategies, study design and patient-centred outcome measures. Results: Strategies for successful implementation in this population focused on determining (1) eligibility criteria for programme inclusion and (2) adaptations to the DPP-GLB curriculum including caregiver involvement, TBI-specific physical activity and nutrition recommendations and tracking and presentation of the content. Conclusions: If it is shown to be effective in this population, the modified DPP-GLB for TBI will provide a model for implementation in a variety of community settings.

Developing a peer-based healthy lifestyle program for people with serious mental illness in supportive housing

Overweight and obesity disproportionally impact people with serious mental illness (SMI). Healthy lifestyle interventions can improve the health of people with SMI but may need to be adapted for this population. The aims of this study were: to (1) examine the feasibility and acceptability of delivering the Peer-based Group Lifestyle Balance (PGLB) intervention and (2) describe intervention adaptations for people with SMI in supportive housing. Peer specialists and social workers co-facilitated 12 weekly PGLB sessions for 14 supportive housing clients. We conducted structured interviews and collected qualitative data through field notes and two focus groups. Frequencies and measures of central tendencies were used to describe participant characteristics and PGLB feasibility and acceptability measures. Qualitative data was analyzed using directed content analysis. Participants on average attended 8 of 12 sessions, and reported that services were satisfactory and helpful. Intervention adaptations, ongoing throughout the study, focused on adding peer-specialists as co-facilitators, increasing individualized support and developing strategies to address socioeconomic barriers impacting participants' ability to engage in healthy lifestyle changes. Study findings suggest that participants with SMI in supportive housing perceived PGLB as feasible and acceptable. Expanding the relevance and reach of peer-based healthy lifestyle interventions in community settings serving people with SMI requires careful adaptations to the socioeconomic realities of this population and the complexities of living with co-morbid health and mental health conditions.

Impact of a community-based lifestyle intervention program on health-related quality of life.

The presence of risk factors for type 2 diabetes and cardiovascular disease, or the conditions themselves, contributes to lower health-related quality of life (HRQoL) among adults. Although community-based lifestyle intervention programs have been shown to be effective for improving risk factors for these diseases, the impact of these interventions on HRQoL has rarely been described. To examine changes in HRQoL following participation in the Group Lifestyle Balance program, a community translation of the Diabetes Prevention Program lifestyle intervention for adults with prediabetes and/or the metabolic syndrome. Participants enrolled in the 12-month, 22-session intervention program (N=223) completed the EuroQol Health Questionnaire (EQ-5D-3L) at baseline, 6, and 12months. Linear mixed-effects regression models determined change in EQ-5D-visual analog scale (VAS) and Index scores post-intervention. Mean EQ-5D-VAS was improved by +7.38 (SE=1.03) at 6months and by +6.73 (SE=1.06) at 12months post-intervention (both; p<0.0001). Mean changes in EQ-5D index values were +0.00 (SE=0.01; NS) and +0.01 (SE=0.01; p<0.05), respectively. Adjusted for age, baseline score, and achieving intervention goals, mean change in EQ-5D-VAS was +11.83 (SE=1.61) at 6months and +11.23 (SE=1.54) at 12months (both; p<0.0001). Adjusted mean change in EQ-5D index value was +0.04 (SE=0.01) at 6months and +0.05 (SE=0.01) at 12months (both; p<0.01). Participation in a community lifestyle intervention program resulted in improved HRQoL among adults with prediabetes and/or the metabolic syndrome. These benefits to HRQoL, together with improved clinical and behavioral outcomes, should increase the appeal of such programs for improving health.

OBESITY MANAGEMENT IN THE PRIMARY CARE SETTING BY AN INTENSIVE LIFESTYLE INTERVENTION

the aim of this study was to compare an Intensive Lifestyle Intervention against Traditional Treatment for obesity management in the primary care setting. interventional randomized controlled study with participation of 42 obese adults. Subjects assigned to the Intensive Lifestyle Intervention received a validated behavior change protocol "Group Lifestyle Balance" in 12 sessions, weekly consultations by a nutritionist and meal replacements. Traditional Treatment consisted of monthly consultations with a nutritionist that provided nutritional assessment and physical activity. almost all study participants (97%) were measured after 3 months of intervention. Intensive Lifestyle Intervention and Traditional Treatment subjects showed the following changes in body weight: (Median [25-75th percentile]) (-4.7 kg [-6.5, -3.1]) vs. (+0.4 kg [-0.3, 1.3]). Sixty two percent of Intensive Lifestyle Intervention group participants lost more than 5 % body weight vs. 0 % in the traditional treatment group (p < 0.001). this preliminary evidence showed that an Intensive Lifestyle Intervention can be an effective strategy for obesity management in the primary care setting.

Yoga Combined With Health Education for Risk Reduction of Metabolic Syndrome: A Randomized Controlled Pilot Feasibility Study

Objective: The primary treatment for adults with risk factors for metabolic syndrome is lifestyle change, though adoption of traditional lifestyle programs is often limited. This pilot study tested the feasibility of conducting a randomized clinical trial comparing a novel targeted yoga program coupled to lifestyle education versus lifestyle education alone among adults with metabolic syndrome risk factors. Design and methods: Patients from primary care clinic were pre-screened electronically and further screened for metabolic syndrome. Consented participants were randomized to either a 12-week yoga program with lifestyle education or lifestyle education alone. Participants in the yoga arm received weekly 30 to 45 min of face-to-face yoga instruction, followed by 30 to 45 min of lifestyle education, and written instructions for home yoga practice and lifestyle changes. The lifestyle education was based on (EDU) the Group Lifestyle Balance Program that is adapted from the Diabetes Prevention Program. Participants in EDU only group received a weekly standardized curriculum matched in attention and time to the yoga with EDU arm. The primary outcome was to assess the feasibility of conducting a randomized trial by assessing recruitment rate and adherence to the protocol. Secondly, we aimed to collect preliminary data on changes in cardiometabolic factors including insulin resistance (IR) as measured by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), blood pressure, fasting lipids, body weight and composition, habitual physical activity, and dietary intake from baseline to 12-week intervention. Results: We identified 238 adults at high risk for metabolic syndrome medical records review utilizing an electronic recruitment tool. Among eligible individuals, 67 (28%) were enrolled and 56 (84%) completed the 12-week assessment. The median attendance was 8 of 12 sessions for the yoga with EDU and 9 of 12 sessions for the EDU arm. Self-reported median frequency of home practice was 2.8 (IQR 1.4) times per week among the yoga with EDU group and 3.3 (IQR 1.1) times per week among the EDU group. Participants in the yoga with EDU arm versus EDU alone demonstrated a non-significant decrease in HOMA-IR (-0.21 (S.D. 0.99) versus 0.02 (S.D. 0.74), p=0.29). Both groups had similar changes in blood pressure, lipids, weight, body composition, energy intake, and physical activity from baseline to 12 weeks. Conclusions: It is feasible to implement yoga combined with EDU and conduct a prospective trial to assess effectiveness on cardiometabolic risk reduction in adults with metabolic syndrome.

Increasing the effectiveness of the Diabetes Prevention Program through if-then plans: study protocol for the randomized controlled trial of the McGill CHIP Healthy Weight Program.

BackgroundThe Diabetes Prevention Program (DPP) is highly effective in promoting weight loss in overweight and obese individuals. However, one-on-one DPP sessions are costly. As a cost-saving alternative, a group version of the DPP, called Group Lifestyle Balance program (GLB), has been developed but has been shown to be less effective. The aim of this two-arm parallel randomized controlled trial is to increase the effectiveness of the GLB by integrating habit formation techniques, namely if-then plans and their mental practice, into the program.Methods/DesignA total of 154 participants will be randomized to a standard or enriched GLB program. For the enriched GLB program, if-then plans and their mental practice will be integrated into the standard GLB program. Participants will be overweight or obese men and women (BMI of 28 to 45 kg/m2, waist circumference ≥ 88 for women, ≥ 102 for men, 18 to 75 years of age) who do less than 200 minutes of self-reported moderate or vigorous exercise per week. Measures will be completed at baseline, 3 months, post-intervention (12 months), and 12 months post-intervention (24 months). The primary outcome measure is weight loss at 3, 12, and 24 months. Secondary outcomes include percent reaching weight loss goal, physical activity at 3, 12, and 24 months, and weight-related risk factors (waist circumference, hemoglobin A1c, systolic/diastolic blood pressure, total cholesterol/HDL ratio). Standardized training of the life-style coaches, use of standardized manuals, and audio taping and reviewing of the sessions will ensure intervention fidelity.DiscussionThe study will provide evidence-based data on the effectiveness of an enhanced GLB intervention in promoting weight loss and in reducing weight-related risk factors for chronic health problems. Ethical clearance has been received from the Research Ethics and Compliance Board of the Faculty of Medicine Research and Graduate Studies Office at McGill University (Montreal, Canada).Trial registrationClinicalTrials.gov Identifier: NCT02008435. Registered 6 December 2013.

Abstract 29: Virtual Small Groups for Weight Management: An innovative delivery mechanism for evidence-based lifestyle interventions

Background: Innovative, feasible and effective treatment strategies are urgently needed to address the obesity epidemic. While group interventions for weight loss have been shown to be efficacious, adherence is often low due to participant burden in attending in-person weekly meetings. Technology offers the potential for highly scalable intervention strategies that can be disseminated in diverse settings, and may improve access and adherence. This study assessed the feasibility and effectiveness of using virtual small groups for weight loss treatment. Methods: Obese men (BMI ≥30kg/m 2 ) age 21-60 years, were recruited within a primary care clinic. We delivered an adapted Group Lifestyle Balance curriculum , based on the Diabetes Prevention Program lifestyle intervention, for 3-months using synchronous, encrypted, web-based video conferencing. Each session allowed for 8 participants and 1 facilitator, all attending from their own personal computer. Body weight was remotely monitored weekly using wireless scales. Participants (n= 48) were randomized to receive the intervention immediately following the baseline assessment, or 3-months later, as a delayed intervention control group. The main outcome of mean change in body weight was compared between intervention and control groups using student’s t-test. Results: Baseline characteristics did not differ between the intervention (n = 25) and delayed intervention control groups (n = 23). Intervention participants lost more weight than those in the delayed intervention control group, losing on average 4.3% (95% CI: -5.9%, -2.6%, P = 0.0004) of their initial body weight. The decrease in body weight was greater among men in the intervention group than in the delayed control group, with a mean difference of -3.9 kg (-5.9kg, -1.9kg, P = 0.0003) and mean difference for BMI of-1.2 kg/m 2 (-1.9 kg/m 2 ,-0.4 kg/m 2 , P = 0.0021). On average, of the 12 weeks of the intervention, participants transmitted weekly weights 10.2 times (9.1,11.3) and attended 9.0 sessions (7.9, 10.0), or 74.7% (9 of 12) of total sessions offered. Conclusion: This pilot study is the first attempt to our knowledge to evaluate the delivery of a group behavior weight loss intervention via video conferencing in a primary care setting. Virtual small groups may be an effective means of healthcare service delivery and allow for face-to-face group interaction, while overcoming some barriers to access that a participant of an in-person program may face.

Adapting the Group Lifestyle Balance™ Program for Weight Management Within a Large Health Care System Diabetes Education Program

The purpose of this translation study was to evaluate the feasibility and effectiveness of an adapted Group Lifestyle Balance (GLB) intervention for weight management implemented through an existing diabetes education program within a large health care delivery system for overweight/obese individuals with diabetes, prediabetes, or neither condition. Adults with BMI ≥ 25 kg/m2 participated in an adapted GLB intervention designed to be appropriate regardless of diabetes status. Effectiveness was based on changes in weight and minutes of physical activity between baseline and completion of the 12-week core. Differences between subjects based on diabetes status were also examined. A total of 111 subjects with diabetes, prediabetes, and no diabetes completed baseline survey data and attended at least 9 of the 12 core sessions from April 2010 through December 2011. All achieved significant weight loss, and the proportion of subjects who reported exercising at least 150 minutes/week increased. The adapted GLB intervention for weight management implemented through an existing diabetes education program in a large health care system was feasible and effective in the population, regardless of participants' diabetes status.

Design of a cluster-randomized controlled trial of a diabetes prevention program within African–American churches: The Fit Body and Soul study

Evidence from varied community settings has shown that the Group Lifestyle Balance (GLB) Program and other adaptations of the Diabetes Prevention Program (DPP) intervention are effective in lowering diabetes risk. Most DPP data originated from studies of pre-diabetic whites, with only sparse evidence of the effect of DPP in African Americans (AAs) in community settings. This paper describes the design, methods, baseline characteristics and cost effective measures, of a single-blinded, cluster-randomized trial of a faith-based adaptation of the GLB program, Fit Body and Soul (FBAS). The major aims are to test efficacy and cost utility of FBAS in twenty AA churches. Randomization occurred at the church level and 604 AA overweight/obese (BMI≥25kg/m2) adults with fasting plasma glucose range from normal to pre-diabetic received either FBAS or a health-education comparison program. FBAS is a group-based, multi-level intervention delivered by trained church health advisors (health professionals from within the church), with the goal of ≥7% weight loss, achieved through increasing physical activity, healthy eating and behavior modification. The primary outcome is weight change at 12weeks post intervention. Secondary outcomes include hemoglobin A1C, fasting plasma glucose, waist circumference, blood pressure, physical activity level, quality of life measures, and cost-effectiveness. FBAS is the largest known cohort of AAs enrolled in a faith-based DPP translation. Reliance on health professionals from within the church for program implementation and the cost analysis are unique aspects of this trial. The design provides a model for faith-based DPPs and holds promise for program sustainability and widespread dissemination.

Comparative effectiveness of lifestyle intervention efforts in the community: results of the Rethinking Eating and ACTivity (REACT) study.

OBJECTIVETo determine the comparative effectiveness of three lifestyle intervention modalities in decreasing risk for diabetes.RESEARCH DESIGN AND METHODSFive hundred and fifty-five individuals (86.1% female, 95.1% white, and 55.8% obese) from eight rural communities were screened for BMI ≥25 kg/m2 and waist circumference >40 inches in men and >35 inches in women. Communities with their eligible participants (n = 493; mean age 51 years, 87.6% female, 94.1% Caucasian) were assigned to four Group Lifestyle Balance (GLB) intervention groups: face to face (FF) (n = 119), DVD (n = 113), internet (INT) (n = 101), and self-selection (SS) (n = 101). SS participants chose the GLB modality. GLB is a comprehensive lifestyle behavior–change program.RESULTSA marked decline was observed in weight after the intervention in all groups (FF −12.5 lbs, P = 0.01; DVD −12.2 lbs, P < 0.0001; INT −13.7 lbs, P < 0.0001; and SS −14 lbs, P < 0.0001). Participants in SS experienced the largest average weight loss. Weight loss was sustained in >90% of participants in each group at 6 months (FF 90.7%, DVD 90.9%, INT 92.1%, and SS 100%). All groups experienced improvements in the proportion of participants with CVD risk factors. The proportion of individuals with CVD risk factors remained steady between 3 and 6 months in all groups and never returned back to baseline. All associations remained after multivariate adjustment.CONCLUSIONSDespite the modality, the GLB intervention was effective at decreasing weight and improving CVD risk factor control. SS and FF participants experienced greater improvements in outcomes compared with other groups, establishing the importance of patient-centered decision making and a support network for successful behavior change.

A smartphone-supported weight loss program: design of the ENGAGED randomized controlled trial

BackgroundObesity remains a major public health challenge, demanding cost-effective and scalable weight management programs. Delivering key treatment components via mobile technology offers a potential way to reduce expensive in-person contact, thereby lowering the cost and burden of intensive weight loss programs. The ENGAGED study is a theory-guided, randomized controlled trial designed to examine the feasibility and efficacy of an abbreviated smartphone-supported weight loss program.Methods/designNinety-six obese adults (BMI 30–39.9 kg/m2) will be randomized to one of three treatment conditions: (1) standard behavioral weight loss (STND), (2) technology-supported behavioral weight loss (TECH); or (3) self-guided behavioral weight loss (SELF). All groups will aim to achieve a 7% weight loss goal by reducing calorie and fat intake and progressively increasing moderate intensity physical activity to 175 minutes/week. STND and TECH will attend 8 group sessions and receive regular coaching calls during the first 6 months of the intervention; SELF will receive the Group Lifestyle Balance Program DVD’s and will not receive coaching calls. During months 1–6, TECH will use a specially designed smartphone application to monitor dietary intake, body weight, and objectively measured physical activity (obtained from a Blue-tooth enabled accelerometer). STND and SELF will self-monitor on paper diaries. Linear mixed modeling will be used to examine group differences on weight loss at months 3, 6, and 12. Self-monitoring adherence and diet and activity goal attainment will be tested as mediators.DiscussionENGAGED is an innovative weight loss intervention that integrates theory with emerging mobile technologies. We hypothesize that TECH, as compared to STND and SELF, will result in greater weight loss by virtue of improved behavioral adherence and goal achievement.Trial registrationNCT01051713

Two-Year Results of Translating the Diabetes Prevention Program Into an Urban, Underserved Community

The purpose of the study was to examine the long-term effect of a Group Lifestyle Balance (GLB) program on weight, impaired fasting glucose, hypertension, and hyperlipidemia in an urban, medically underserved community. This study was a single-arm prospective intervention study that was designed to test the effectiveness of a community-based GLB intervention. In sum, 638 residents from 11 targeted neighborhoods were screened for body mass index ≥ 25 kg/m(2) and metabolic syndrome. Eligible individuals took part in a 12-week GLB intervention (n = 105) that addressed weight loss and physical activity. Subjects were followed for 24 months. The probability of being at risk for diabetes and cardiovascular disease was significantly reduced by 25.7% over the long-term follow-up. Of the participants who lost at least 5% of their body weight following the intervention, 52.6% maintained the 5% weight loss at their last follow-up time, weighing about 20 lb less than they did at baseline. Risk reduction and weight loss maintenance are possible following a GLB intervention and have substantial potential for future public health impact.