Behavioral Weight Management Research Articles

Abstract P254: Mental Well-Being of Caregivers With Overweight and Obesity is Associated With Cognitive Stimulation Provided to Children in the Home

Introduction: Parents with poor mental health are less likely to engage in cognitively enriching parenting behaviors, such as reading and playing with their children. This, in turn, is associated with increased risk of obesity in the child and poor treatment outcomes for children enrolled in behavioral weight management. Parents and caregivers with obesity also have worse mental health and lower life satisfaction than their non-obese counterparts. Among parents with overweight and obesity who have a child with overweight/obesity, the relationship between parent mental health and cognitive enrichment provided in the home is unknown. Hypothesis: We hypothesize that higher depressive symptoms and lower subjective well-being scores among parents will be associated with less cognitive enrichment provided to children. Further, we hypothesize that these relationships will be moderated by the sex of the parent. Methods: This study was a secondary analysis of baseline data from 452 parent-child dyads with overweight/obesity enrolled in a family-based behavioral treatment study for obesity. Depression symptoms and subjective well-being were assessed using the Patient Health Questionnaire-9 scale and the MacArthur Scale of Subjective Social Status, respectively. Cognitive stimulation was measured with the Cognitive Stimulation subscale of the Environmental Enrichment scale. Univariable relationships were assessed using Pearson correlations. Multivariable linear regression models were used to control for study site, parent characteristics (age, BMI, sex, race/ethnicity, education), child characteristics (age, and sex), and family characteristics (health insurance status and household income). Results: Higher depression symptom score was correlated with lower cognitive stimulation (ρ = -0.165, p < 0.001), whereas higher subjective well-being was associated with higher cognitive stimulation (ρ = 0.377, p < 0.001). These relationships were maintained even after controlling for covariates in the multivariable models, with each one-unit increase in depression symptoms associated with a 0.16 unit decrease in cognitive stimulation (95% CI -0.27 to -0.06, p = 0.003) and each one-unit increase in subjective well-being associated with a 0.04 unit increase in cognitive stimulation (95% CI 0.01, 0.07, p = 0.01). Parent sex did not moderate these effects. Conclusions: Mental well-being of parents and caregivers with overweight/obesity is associated with the degree of cognitive enrichment provided to the child in the home, though the effect sizes after controlling for covariates were modest. Thus, interventions targeting parental wellbeing offer a potential avenue to improve their child’s cognitive wellbeing and response to obesity treatment.

Weight Loss Expectations of Adults With Binge Eating: Cross-sectional Study With a Human-Centered Design Approach.

People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight. The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations. A total of 760 adults (n=504, 66% female; n=441, 58% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight. Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape. In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals' intended treatment goals to facilitate engagement and successful outcomes in a digital intervention.

Identifying Factors Which Influence Eating Disorder Risk during Behavioral Weight Management: A Consensus Study.

This study aimed to understand clinician, researcher and consumer views regarding factors which influence eating disorder (ED) risk during behavioral weight management, including individual risk factors, intervention strategies and delivery features. Eighty-seven participants were recruited internationally through professional and consumer organizations and social media and completed an online survey. Individual characteristics, intervention strategies (5-point scale) and delivery features (important/unimportant/unsure) were rated. Participants were mostly women (n = 81), aged 35-49 y, from Australia or United States, were clinicians and/or reported lived experience of overweight/obesity and/or ED. There was agreement (64% to 99%) that individual characteristics were relevant to ED risk, with history of ED, weight-based teasing/stigma and weight bias internalization having the highest agreement. Intervention strategies most frequently rated as likely to increase ED risk included those with a focus on weight, prescription (structured diets, exercise plans) and monitoring strategies, e.g., calorie counting. Strategies most frequently rated as likely to decrease ED risk included having a health focus, flexibility and inclusion of psychosocial support. Delivery features considered most important were who delivered the intervention (profession, qualifications) and support (frequency, duration). Findings will inform future research to quantitatively assess which of these factors predict eating disorder risk, to inform screening and monitoring protocols.

The Role of Change in Self-efficacy in Maintaining Exercise-Associated Improvements in Mood Beyond the Initial 6 Months of Expected Weight Loss in Women with Obesity.

Although mechanisms are unclear, there is a robust association between exercise and mood improvements. However, beyond ~ 6months of expected weight loss, weight-management behaviors such as exercise wane as weight gradually regains in most adults. The amount of exercise required to maintain mood improvement is unknown, as is the possible role of theory-based psychosocial changes associated with treatment such as in self-efficacy. Women who volunteered for a community-based cognitive-behavioral obesity treatment emphasizing exercise and building self-efficacy via self-regulating through lifestyle challenges/barriers, and were of the 86% who reduced their negative mood during its initial 6months, were allocated into groups who either maintained their negative mood reduction (Sustain group, n = 43) or reverted toward initial levels of negative mood (Revert group, n = 73) during months 6-24. A binary stepwise logistic regression analysis assessed whether exercise amount and/or change in self-efficacy significantly classified Sustain vs. Revert group membership. Change in exercise amount was not significantly associated with group membership. However, after additional entry of change in exercise self-efficacy, a significant association was found - successfully classifying 70% and 42% of the Revert and Sustain group participants, respectively. When self-efficacy change was entered as the sole independent variable, group membership was classified with 62% accuracy, overall (96% in the Revert group). Consistent with behavioral explanations of the exercise-mood change relationship, it was interpreted that self-efficacy, rather than exercise amount, was an important correlate of mood change beyond month 6. Suggestions for bolstering self-efficacy later in behavioral obesity treatments were provided.

Eating Disorders In weight-related Therapy (EDIT) Collaboration: rationale and study design.

The cornerstone of obesity treatment is behavioural weight management, resulting in significant improvements in cardio-metabolic and psychosocial health. However, there is ongoing concern that dietary interventions used for weight management may precipitate the development of eating disorders. Systematic reviews demonstrate that, while for most participants medically supervised obesity treatment improves risk scores related to eating disorders, a subset of people who undergo obesity treatment may have poor outcomes for eating disorders. This review summarises the background and rationale for the formation of the Eating Disorders In weight-related Therapy (EDIT) Collaboration. The EDIT Collaboration will explore the complex risk factor interactions that precede changes to eating disorder risk following weight management. In this review, we also outline the programme of work and design of studies for the EDIT Collaboration, including expected knowledge gains. The EDIT studies explore risk factors and the interactions between them using individual-level data from international weight management trials. Combining all available data on eating disorder risk from weight management trials will allow sufficient sample size to interrogate our hypothesis: that individuals undertaking weight management interventions will vary in their eating disorder risk profile, on the basis of personal characteristics and intervention strategies available to them. The collaboration includes the integration of health consumers in project development and translation. An important knowledge gain from this project is a comprehensive understanding of the impact of weight management interventions on eating disorder risk.

Intuitive Eating Behaviour among Young Malay Adults in Malaysian Higher Learning Institutions

Despite the significance of dietary knowledge interventions, there is a lack of established studies on intuitive eating behaviour among young Malay adults in Malaysia. This cross-sectional study aimed to determine the intuitive eating score, identify the intuitive eating factors, and determine the association of intuitive eating with weight-control behaviours and binge eating. A total of 367 respondents completed self-administered questionnaires on sociodemographic characteristics, namely the Intuitive Eating Scale (IES-2) and The Diabetes Eating Problems Survey (DEPS). The findings reported IES-2 mean scores of 3.52 ± 0.32 and 3.47 ± 0.35 for both men and women. No difference in total IES-2 scores was found between genders for Unconditional Permission to Eat (UPE) and Reliance on Hunger and Satiety Cue (RHSC) subscales (p > 0.05). However, among all four subscales of IES-2, there was a gender difference in the mean EPR and B-FCC subscale scores (p < 0.05). A statistically significant difference was found in intuitive eating, which refers to a belief in one's body's ability to tell one how much to eat, in women across living areas (p < 0.05). The result shows that there is a relationship between weight-control behaviour and binge eating and dieting, with the coefficient of the relationship (R2) of 0.34. As a result, intuitive eating throughout young adulthood is likely to be related to a decreased prevalence of obesity, dieting, poor weight-management behaviours, and binge eating.

Does Healthcare Provider Counseling for Weight Management Behaviors among Hispanic Adults Who Are Overweight/Obese Vary by Acculturation Level?

This cross-sectional study explored differences in the receipt of health care provider (HCP) counseling to control/lose weight and adopt weight-related lifestyle behavior changes among Hispanic respondents according to acculturation level. Differences in reported action regarding HCP counseling were also examined. Data from four National Health and Nutrition Examination Survey (NHANES) cycles (2011-2018) were analyzed, with the analytic sample limited to Hispanic respondents who were overweight/obese. Respondents' acculturation levels were derived from their reported country of origin and the primary language spoken at home. Respondents who reported speaking only Spanish or more Spanish than English at home were classified as primarily speaking Spanish at home. In contrast, those who reported speaking Spanish and English equally, more English than Spanish, or only English were categorized as primarily speaking English at home. Weighted multivariate logistic regression models were utilized to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine if differences in acculturation levels existed regarding the likelihood of receiving HCP counseling to (1) control/lose weight, (2) increase exercise/PA, and (3) reduce fat/calorie intake. Similar analyses examined differences in reported action regarding HCP counseling according to acculturation level. The analysis found no significant differences in receiving HCP counseling according to acculturation level. However, non-US-born respondents who primarily spoke Spanish at home were less likely than US-born respondents to report acting to control/lose weight (p = 0.009) or increase exercise/PA (p = 0.048), but were more likely to report having taken action to reduce fat/calorie intake (p = 0.016). This study revealed differences between acting on recommendations of health care professionals according to acculturation level, indicating a need for interventions tailored to acculturation levels.

Weight Management Behaviors are Associated with Elevated Glycemic Outcomes in Adolescents and Young Adults with Type 1 Diabetes.

Many adolescents and young adults (AYAs) with type 1 diabetes (T1D) engage in weight management behaviors (i.e., trying to lose weight), and efforts to manage weight may impact glycemic control. We assessed objective/subjective weight status and weight management behaviors in a diverse sample of 76 AYAs with T1D, and examined differences in sociodemographic characteristics and A1c levels by the following categories: (1) Overweight BMI/weight management (n = 21), (2) overweight BMI/no weight management (n = 6), (3) in/below-range BMI/weight management (n = 25), (4) in/below-range BMI/no weight management (n = 24). Subjective overweight status was more common among late adolescents and females; female gender was associated with weight management behaviors. AYAs endorsing weight management behaviors evidenced higher A1c values than those who did not. Clinicians working with AYAs should be aware of associations among weight management and glycemic indicators and routinely screen for weight management behaviors. Future research should explore interventions to promote healthy lifestyle behaviors among AYAs.

Predicting Clinically Significant Weight Loss in a Multimodal Commercial Digital Weight Management Program: Machine Learning Approach

Background Generally, adherence to diet and physical activity in behavioral weight management programs predicts weight loss. Moreover, meeting attendance and platform or app use predict weight loss. Many weight-loss–prediction studies primarily use regression. However, little is known about the levels of adherence to specific web-based weight management program tools as well as behavioral and psychosocial variables that predict significant weight loss using machine-learning approaches. Objective In this paper, we aimed to examine variables that can predict clinically significant weight loss (≥5%) in a multimodal commercial digital weight management program, including levels of adherence to intervention tools and changes in behavioral and psychosocial states using machine-learning approaches. Methods We performed secondary analyses using data from a one-arm trial online WW (formerly Weight Watchers) weight-loss intervention program, lasting 6 months, that recruited US adults with a BMI range of 25-45 kg/m2. We used a WW Bluetooth scale and digital intervention tools such as mobile app for point tracking, weekly virtual workshops, weekly wellness check-ins and a Facebook group, and changes in psychosocial and behavioral variables (ie, food craving, Pittsburgh sleep quality index, diet, hunger, and physical activity). Using the receiver operating characteristics (ROC) curve, we identified the predictors of significant weight loss, as well as the associated cut points (CP) and area-under-curve (AUC) values for each variable. We further used a classification tree to confirm the importance of these predictors and assessed the out-of-sample prediction accuracies using 5-fold cross-validation. Results Participants (N=153) were 70% female and 66% White, with a mean age of 41.09 (SD 13.78) years, and had a mean BMI of 31.8 kg/m2 (SD 5.0). Approximately 51% of participants lost ≥5% weight. Using ROC curve, food tracking (CP≥9.4%; AUC=0.744; P&lt;.001), increase in self-weighing (CP≥0.5; AUC=0.733; P&lt;.001), wellness check-in attendance (CP≥31.3%; AUC=0.723; P&lt;.001), and workshop attendance (CP≥35.4%; AUC=0.699; P&lt;.001) were identified as significant predictors of achieving ≥5% weight loss. We confirmed the importance of these variables using classification tree, and together they achieved an out-of-sample prediction accuracy of 78%. Conclusions ROC curve and classification tree provided consistent results of predictors of clinically significant weight loss (ie, food tracking, increase in self-weighing, workshop attendance, and wellness check-in attendance). Our study extends the weight management literature by using machine-learning approaches to identify significant weight loss predictors and specific levels of these predictors needed to achieve clinically significant weight loss. Conflicts of Interest None declared.

Empirical validation of the information-motivation-behavioral skills model of gestational weight management behavior: a framework for intervention

BackgroundUnhealthy gestational weight gain is a modifiable risk factor for adverse maternal and child health. Appropriate and effective intervention strategies that focus on behavioral change or maintenance are critical in weight management during pregnancy. Our aim was to uncover the influencing factors and psychosocial mechanisms of gestational weight control behavior, and to construct a behavioral model suitable for intervention based on Information-Motivation-Behavioral skills (IMB) model.MethodsA sample of 559 pregnant women from a municipal maternal and child healthcare facility in Jiangsu Province, China was enrolled in this cross-sectional empirical study. Partial least square structural equation modelling was used to verify the hypothesized model, and post hoc analyses was used to test the effect of parity and pre-pregnancy BMI on the model.ResultsThe IMB model elements can predict gestational weight management (GWM) behavior well, with information being the most influential factor. As predicted, information affects GWM directly (β = 0.325, p < 0.05) and indirectly (β = 0.054, p < 0.05) through behavioral skills. Likewise, motivation has direct (β = 0.461, p < 0.05) effects on GWM, and has indirect (β = 0.071, p < 0.05) effects through behavioral skills. Behavioral skills have a direct impact (β = 0.154, p < 0.05). The model had a goodness of fit (GOF = 0.421) and was robust when tested in subgroups of different parity or pre-pregnancy BMI.ConclusionFindings from this study supported the predictions of the IMB model for GWM behavior, and identified its modifiable determinants. The tested behavior model for GWM can serve as a new validated intervention strategy in weight management among pregnant women.

Weight regain and mental health outcomes following behavioural weight management programmes: A systematic review with meta-analyses.

Behavioural weight management programmes (BWMPs) lead to weight loss but subsequent weight regain may harm mental health outcomes. We searched for randomised trials of BWMPs in adults with overweight/obesity with follow-up ≥12 months from baseline that measured weight change both at and after programme-end. We included only studies reporting mental health at or after programme-end. We meta-analysed changes in various mental health outcomes using a random-effects model by nature of the comparator group and by time since programme end. Subgroup analysis explored heterogeneity. We used mixed models and meta-regression to analyse the association between change in weight and change in depression and/or anxiety over time, with higher scores indicating greater depression and/or anxiety. We included 47 studies. When comparing BWMPs (diet and/or exercise) to control, most estimates included the possibility of no difference, but pooled estimates for psychological wellbeing, self-esteem and mental-health composite scores at programme-end, anxiety at 1-6months, and depression at 7-12 months after programme-end suggested improvements in intervention arms relative to control, with 95% CIs excluding no difference. Pooled estimates found no evidence that BWMPs harmed mental health at programme end or beyond. Mental health composite scores at programme-end favoured diet and exercise interventions over diet alone, with 95% CIs excluding no difference. All other measures and timepoints included the possibility of no difference or could not be meta-analysed due to high heterogeneity or a paucity of data. Mixed models and meta-regression of the association between change in depression and/or anxiety scores over time, and change in weight, were inconclusive. Despite weight regain after BWMPs, our meta-analyses found no evidence of mental health harm and some evidence that BWMPs may improve some dimensions of mental health at and after programme-end.

Weight Management Behaviors among Students in a Public University

Background: Obesity is the most common health concern among the public worldwide. Weight gain among students occurred during their college years, when physical activity and dietary patterns were observed to change. The Health Belief Model (HBM) depicts the role of anticipating and justifying the causes of a person's transformation or maintenance of specific health behaviors. Objective: This study determines the prevalence of obesity and the differences in weight management behaviours with gender among university students. Methods: A cross-sectional study was conducted at Universiti Teknologi MARA (UiTM) Puncak Alam Campus, Selangor, involving 377 respondents (122 males and 255 females) aged 18-26 years from February to April 2021. Health Belief Model (HBM) questionnaire on Weight Management Behaviors was used as a research tool in this study. Results: The findings showed that the majority of the respondents have a normal Body Mass Index (BMI) (n=214, 56.8%), followed by overweight (n=66, 17.5%), underweight (n=63, 16.7%) and obese (n=34, 9.0%). Independent t-test showed that female students significantly have more perceived susceptibility and cues to action than males (p&lt;0.05). While, male students significantly have a high score in weight management behaviour for perceived benefits, perceived self-efficacy in dieting, and behavioural intention of weight management compared to female (p&lt;0.05). Conclusion: Health interventions such as nutrition education regarding healthy food preparation and exercise schedule, including duration and types of activity, should increase female students' motivation and confidence in managing weight. Besides, an awareness campaign regarding the risk of obesity focusing on the male students must be created to generate awareness and prevention of obesity.

Improving adult behavioural weight management services for diverse UK Black Caribbean and Black African ethnic groups: a qualitative study of insights from potential service users and service providers.

A significantly higher proportion of UK Black ethnic adults live with overweight or obesity, compared to their White British counterparts. The role of obesity in excess infection rates and mortality from COVID-19 has increased the need to understand if weight management interventions are appropriate and effective for Black ethnic groups. There is a paucity of existing research on weight management services in Black populations, and whether anticipated or experienced institutional and interpersonal racism in the healthcare and more widely affects engagement in these services. Understanding the lived experience of target populations and views of service providers delivering programmes is essential for timely service improvement. A qualitative study using semi-structured interviews was conducted in June-October 2021 among 18 Black African and Black Caribbean men and women interested in losing weight and 10 weight management service providers. The results highlighted a positive view of life in the United Kingdom (UK), whether born in the UK or born abroad, but one which was marred by racism. Weight gain was attributed by participants to unhealthy behaviours and the environment, with improving appearance and preventing ill health key motivators for weight loss. Participants relied on self-help to address their overweight, with the role of primary care in weight management contested as a source of support. Anticipated or previously experienced racism in the health care system and more widely, accounted for some of the lack of engagement with services. Participants and service providers agreed on the lack of relevance of existing services to Black populations, including limited culturally tailored resources. Community based, ethnically matched, and flexibly delivered weight management services were suggested as ideal, and could form the basis of a set of recommendations for research and practice. Cultural tailoring of existing services and new programmes, and cultural competency training are needed. These actions are required within systemic changes, such as interventions to address discrimination. Our qualitative insights form the basis for advancing further work and research to improve existing services to address the weight-related inequality faced by UK Black ethnic groups.

IMPROVING THE PERFORMANCE OF COMMUNITY HEALTH WORKERS IN A BEHAVIORAL LIFESTYLE INTERVENTION FOR OLDER ADULTS

Abstract Community health workers (CHWs) play essential roles in implementing community-based behavioral lifestyle interventions. This qualitative analysis aimed to explore what program factors and CHW characteristics would help improve CHW performance in the Mobility and Vitality Lifestyle Program (MOVE UP), a community-based behavioral weight-management intervention for improving mobility among overweight or obese older adults. The MOVE UP program was implemented from January 2015 to June 2019 at 23 community-based sites in Pittsburgh, Pennsylvania. Trained and supported CHWs delivered 32 group sessions over 13 months. We collected data from semi-structured interviews with 21 CHWs and 14 community key informants (community site directors or coordinators); seven focus group discussions with participants from 9 sites, and 124 pieces of graduation advice provided by MOVE UP graduates for future participants; onsite CHW performance observation at 18 sites, and 124 meeting memos of support phone calls with CHWs. Interviews and focus groups were audio-recorded and transcribed verbatim. All data were thematically analyzed in a deductive approach, using the CHW generic logic model. Emerging themes were: Trained CHWs still require onsite support by experienced CHWs or training staff to deliver the first session; Participants need a Q&amp;A session by specialists to address their questions beyond CHWs’ knowledge; Desirable CHW characteristics could increase CHWs’ relation and accessibility to participants, such as the same age group, similar weight loss experience, and living or working in the same community. These findings provide important insight as to recruiting and supporting CHWs in a community-based behavioral lifestyle intervention for older adults.

Weight stigma among adolescents in three low- and middle-income countries.

Overweight (OW) and obesity affect millions of adolescents worldwide. Evidence from high-income countries indicates widespread weight stigma that adversely affects young people's mental and physical health. However, evidence relating to low- and middle-income countries (LMICs) is sparse. We aimed to generate insight into weight stigma prevalence and experience among adolescents in three LMICs. We identified adolescents aged 15-19 from Brazil, South Africa, and Indonesia from families within market research databases. We adopted a mixed-methods design. The sample included equal numbers by country, sex, and age, and included urban and rural dwellers. Self-reported weight was recorded but was not a selection criterion. Consent (age >18) and assent/parental consent (<age 18) were obtained. In-depth interviews (n = 18) informed the survey design. We used a computer-assisted telephonic interviewing survey (n = 1200) to assess weight stigma prevalence and experience. We conducted a qualitative thematic data analysis and used SPSS-23 for quantitative data. Many adolescents affected by OW and some affected by underweight (UW) had experienced weight stigma and expressed negative perceptions of their weight. Negative perceptions were expressed the most by those affected by OW, followed by those affected by UW, and then those of healthy weight (HW). Weight stigma and weight dissatisfaction were highest in Brazil and South Africa, and lower in Indonesia. More young women experienced weight stigma, yet this was also common among young men. One in five of all participants reported negative impacts, predominantly on mental health, and regarding weight management and healthy behaviours. Young people recommended measures to address weight stigma, promote an inclusive model of health and body image, and better support to achieve and maintain a HW. Weight stigma adversely affects sizeable numbers of adolescents in LMICs, particularly those affected by OW. Addressing this is essential to protect adolescent (and future adult) mental and physical health.

Association between Indicators of Inequality and Weight Change following a Behavioural Weight Loss Intervention

Introduction: Weight loss through behavioural weight management interventions can have important health benefits for people with obesity. However, to maximise the health benefits, weight loss must be maintained. Evidence suggests that behavioural weight loss interventions do not exacerbate inequalities in the short term. However, no study has yet considered whether inequalities exist in long-term weight change following intervention. We aimed to investigate if there are inequalities in weight change following weight loss intervention. Methods: We conducted a cohort analysis of data from the Weight Loss Referrals for Adults in Primary Care (WRAP) trial (N = 1,267). WRAP randomised participants to receive a brief intervention information booklet or vouchers for 12-weeks or 52-weeks of WW (formerly WeightWatchers) and followed them for 5 years. Multiple linear regression estimated the association between exposures (indicators of inequality) and outcomes (change in weight between 1- and 5-years). Each model was adjusted for the intervention group, baseline weight, weight change between baseline and 1-year, research centre, and source of the 5-year weight data. Results: Of the 1,267 participants in WRAP, 708 had weight change data available. Mean weight change between 1- and 5-years was +3.30 kg (SD 9.10 kg). A 1 year difference in age at baseline was associated with weight change of 0.11 kg ((95% CI 0.06, 0.16), p < 0.001). We did not find evidence of associations between ethnicity, gender, education, indices of multiple deprivation, household income, or other family members participating in a weight loss programme and weight change. Conclusion: Except for age, we did not find evidence of inequalities in weight change following a behavioural intervention. Findings further support the use of behavioural weight management interventions as part of a systems-wide approach to improving population health.

The prevalence of obesity and lifestyle behaviors of parents of youth with intellectual and developmental disabilities

BackgroundParents of youth with intellectual and developmental disabilities (IDD) may have a higher prevalence of overweight and obesity and poorer weight management behaviors compared to the general population. ObjectiveTo describe the prevalence of overweight/obesity and related socioeconomic and lifestyle factors including diet quality, physical activity, and reported health habits in parents of youth with IDD. MethodsWe assessed: BMI (kg/m2), moderate-to-vigorous physical activity (MVPA), fruit and vegetable intake (FVI), parental diet and physical activity habits, and socioeconomic characteristics. Associations of BMI on MVPA and FVI were assessed with Spearman's correlation; differences in BMI by parental diet and physical activity habits were assessed with Kruskall-Wallis tests; and the relationships of BMI to household income, race, and education were assessed with Kendall Tau-b and Mann Whitney U tests. ResultsData was obtained from 110 parents (97.3% female) who were study partners for their adolescents/young adults with IDD participating in a weight loss clinical trial. Approximately 81% of parents were overweight or obese (25.7% overweight, 55.1% obese), with 46.3% and 20% meeting the recommended U.S. guidelines for MVPA and FVI, respectively. Higher FVI and higher income were significantly associated with lower parent BMI. BMI was significantly lower in parents who reported to be physically active and choose healthy food. ConclusionWe observed a high prevalence of overweight/obesity, low FVI and low levels of MVPA in parents of adolescents with IDD. These observations suggest that interventions designed to address these factors have the potential to improve the health and wellbeing of both parents and adolescents with IDD. Clinical trials numberNCT02561754.

Predictive capacity of COVID-19-related risk beliefs on weight management behaviors on a commercial weight loss program and speed of COVID-19 vaccination uptake: prospective cohort study

BackgroundRecent work has shown that obesity may be a risk factor for severe COVID-19. However, it is unclear to what extent individuals have heard or believe this risk factor information, and how these beliefs may predict their preventive behaviors (e.g., weight management behaviors or COVID-19 preventive behaviors). Previous work has primarily looked at overall risk likelihood perceptions (i.e., not about obesity as a risk factor) within general populations of varying weight and concentrated on COVID-19-related preventive behaviors. Therefore, this prospective cohort study explored whether beliefs about obesity as a risk factor and overall risk likelihood perceptions predicted weight management and COVID-19 preventive behaviors over the next 16 weeks in individuals with obesity or overweight.MethodsParticipants were 393 individuals in the US who joined a commercial weight management program in January, 2021. We leveraged the mobile program’s automatic measurement of real-time engagement in weight management behaviors (e.g., steps taken), while surveys measured risk beliefs at baseline as well as when individuals received COVID-19 vaccination doses (asked monthly) over the next 16 weeks. Mixed effects models predicted engagement and weight loss each week for 16 weeks, while ordinal logistic regression models predicted the month that individuals got vaccinated against COVID-19.ResultsWe found that belief in obesity as a risk factor at baseline significantly predicted greater engagement (e.g., steps taken, foods logged) in program-measured weight management behaviors over the next 16 weeks in models adjusted for baseline BMI, age, gender, and local vaccination rates (minimally adjusted) and in models additionally adjusted for demographic factors. Belief in obesity as a risk factor at baseline also significantly predicted speed of COVID-19 vaccination uptake in minimally adjusted models but not when demographic factors were taken into account. Exposure to obesity risk factor information at baseline predicted greater engagement over 16 weeks in minimally adjusted models.ConclusionsThe results highlight the potential utility of effective education to increase individuals’ belief in obesity risk factor information and ultimately promote engagement or faster vaccination. Future research should investigate to what extent the results generalize to other populations.

Translation, cross-cultural adaptation and validation of the Health Belief Model Questionnaire (HBMQ) for weight management behaviour for use in a Southeast Asian country

Abstract Objectives In the past 50 years, obesity and being overweight have become significant health concerns that cause a rise in the risk of illness, impairing quality of life and increasing financial burdens worldwide. The purpose of the study is to conduct translation and cross-cultural adaptation of a Health Belief Model Questionnaire (HBMQ) for weight management behaviour into the Malay language and to validate the questionnaire. Methods The HBMQ was adapted and translated into the Malay language based on published international guidelines. The content validity and the face validity were analysed by a panel of 10 experts. A pilot test was conducted with 35 students from Universiti Sains Malaysia to evaluate internal consistency. A cross-sectional study was carried out by distributing the self-administered HBMQ to the general public in Malaysia and 505 subjects were successfully recruited. The construct validity was evaluated by exploratory factor analysis. The first 112 participants completed the survey again one week later for the evaluation of test-retest reliability. Key findings In total, 79 questions had an item-level content validity index (I-CVI) score of &amp;gt;0.80 and have been evaluated as excellent inferring acceptable content validity. The remaining seven items in the instrument had an I-CVI score &amp;lt; 0.80 and were removed based on the experts’ consensus. The item-level face validity index value for each item range was between 0.8 and 1.0, indicating a satisfactory level of face validity. For construct validity, eight factors were requested and 74 items had a significant to strong factor loading of &amp;gt;0.4. The rotation of items showed five items had factor loadings &amp;lt;0.4 (item numbers 14, 57, 77, 78 and 79) and have been removed. Conclusions The findings in this study conclude that the translated Health Belief Model-Malay version has adequate content validity, face validity, construct validity and reliability.

Abstract #1318481: Psychological Impact of COVID-19 Pandemic on Waitlisted Prebariatric Surgery Patients in Saudi Arabia: A Cross-Sectional Study

During the COVID-19 pandemic, the number of bariatric surgeries decreased to ensure patient safety. This study aimed to evaluate the effect of such delays on the psychological status and weight management behaviors of waitlisted prebariatric surgery patients in Jeddah, Saudi Arabia.