Peer Reviewed: A Weight Loss Intervention for African American Breast Cancer Survivors, 2006

Introduction

Breast cancer survival rates are lower for African American women than for white women. Obesity, high-fat diets, and lack of regular physical activity increase risk for breast cancer recurrence, comorbid conditions, and premature death. Eighty-two percent of African American women are overweight or obese, partly because of unhealthy eating and exercise patterns. Although successful weight loss and lifestyle interventions for breast cancer survivors are documented, none has considered the needs of African American breast cancer survivors. This study assessed the feasibility and impact of Moving Forward, a culturally tailored weight loss program for African American breast cancer survivors.

Methods

The study used a pre-post design with a convenience sample of 23 African American breast cancer survivors. The 6-month intervention was theory-based and incorporated qualitative data from focus groups with the targeted community, urban African American breast cancer survivors. Data on weight, body mass index (BMI), diet, physical activity, social support, and quality of life were collected at baseline and at 6 months.

Results

After the intervention, we noted significant differences in weight, BMI, dietary fat intake, vegetable consumption, vigorous physical activity, and social support.

Conclusion

This is the first published report of Moving Forward, a weight loss intervention designed for African American breast cancer survivors. Although a randomized trial is needed to establish efficacy, the positive results of this intervention suggest that this weight loss intervention may be feasible for African American breast cancer survivors. Lifestyle interventions may reduce the disparities in breast cancer mortality rates.     

Peer Reviewed: Reach and Effectiveness of a Weight Loss Intervention in Patients With Prediabetes in Colorado

Introduction

Although lifestyle interventions are effective in delaying the onset of diabetes, translating these lessons to routine health care settings remains a challenge. We investigated the effectiveness of a theory-based, brief, small-group weight loss intervention for diabetes prevention. A secondary purpose was to determine the potential reach of the intervention.

Methods

A total of 14,379 members of an integrated health care organization newly diagnosed with prediabetes were potentially eligible to participate in this matched cohort longitudinal study. Of this group, 1,030 attended a 90-minute, small-group session that targeted personal action planning for healthful eating, physical activity, and weight management. We accessed electronic medical records to select 1 to 2 controls (matched on impaired fasting glucose measurement, sex, age, and body mass index) for each member who attended the small-group session (n = 760). Weight change, as recorded in the medical record, was the primary outcome. Mixed models analyses were used to adjust for matching variables and covariates and to account for individual random effects over time.

Results

Small-group participants lost significantly more weight than did their matched controls. A significantly higher proportion of small-group participants lost at least 5% of their body weight compared with controls.

Conclusion

A brief, small-group weight loss intervention was effective. However, it did not reach broadly into the population that was at risk for diabetes.     

Peer Reviewed: Feasibility of an Evidence-Based Weight Loss Intervention for a Faith-Based, Rural, African American Population

Background

African Americans and rural residents are disproportionately affected by obesity. Innovative approaches to address obesity that are sensitive to the issues of rural African Americans are needed. Faith-based and community-based participatory approaches show promise for engaging racial/ethnic minorities to change health outcomes, but few faith-based weight loss interventions have used a community-based participatory approach.

Community Context

A faith-based weight loss intervention in the Lower Mississippi Delta arose from a 5-year partnership between academic and community partners representing more than 30 churches and community organizations.

Methods

Community and academic partners translated the 16 core sessions of the Diabetes Prevention Program for rural, church-going African American adults. The feasibility of the lay health advisor–led delivery of the 16-week (January-May 2010), 16-session, adapted intervention was assessed in 26 participants from 3 churches by measuring recruitment, program retention, implementation ease, participant outcomes, and program satisfaction.

Outcome

Twenty-two of 26 participants (85%) provided 16-week follow-up data. Lay health advisors reported that all program components were easy to implement except the self-monitoring component. Participants lost an average of 2.34 kg from baseline to 16-week follow-up, for a mean weight change of −2.7%. Participants reported enjoying the spiritual and group-based aspects of the program and having difficulties with keeping track of foods consumed. The intervention engaged community partners in research, strengthened community-academic partnerships, and built community capacity.

Interpretation

This study demonstrates the feasibility of delivering this adapted intervention by lay leaders through rural churches.     

Peer Reviewed: Sociodemographic and Health Characteristics Associated With Attempting Weight Loss During Pregnancy

Introduction

Approximately 40% of women of childbearing age report that they are attempting to lose weight. No professional medical organization recommends attempting to lose weight during pregnancy because of the possible risks to both mother and baby. Since half of all pregnancies are unintended, women may attempt to lose weight before they know they are pregnant, and some women may continue or initiate weight loss attempts even after they know they are pregnant. This study examines the extent to which pregnant women report attempting to lose weight and associated sociodemographic and health characteristics.

Methods

We used aggregated multiple-year data (1996-2003) from the Behavioral Risk Factor Surveillance System to assess the prevalence of attempting to lose weight among pregnant women and the extent to which sociodemographic and health characteristics are associated with the behavior.

Results

The prevalence of attempting to lose weight during pregnancy was 8.1%. Attempting to lose weight during pregnancy was associated with age 35-44 years, Hispanic ethnicity, obesity, alcohol consumption, and mental distress during the previous month.

Conclusion

A substantial proportion of pregnant women attempt to lose weight. Preconception and prenatal care should include counseling women to achieve a healthy weight before becoming pregnant, to maintain healthy weight during pregnancy, and not to attempt weight loss during pregnancy. Further research should be conducted to understand how attempting weight loss during pregnancy translates into dietary change and weight loss and associated maternal and fetal outcomes.     

Peer Reviewed: WebEase: Development of a Web-Based Epilepsy Self-Management Intervention

People with epilepsy must adopt many self-management behaviors, especially regarding medication adherence, stress management, and sleep quality. In response to the need for theory-based self-management programs that people with epilepsy can easily access, the WebEase Web site was created and tested for feasibility, acceptability, and usability. This article discusses the theoretical background and developmental phases of WebEase and lessons learned throughout the development process. The WebEase research team developed content for the Web site on the basis of social cognitive theory, the transtheoretical model of behavior change, and motivational interviewing. Formative research and development of the WebEase program included a literature search, computer use survey, a focus group, and review by content experts and consumers. The program has 2 main components: 1) the modules, which provide a tailored opportunity for learning, reflection, and goal setting, and 2) MyLog, a place to enter daily information.     

Peer Reviewed: Childhood Obesity: Issues of Weight Bias

Although the effects of obesity on children''s physical health are well documented, the social consequences of obesity are less well described and may not be addressed in intervention programs. Weight bias may take several forms. It may result in teasing and discrimination and may affect employment and educational opportunities. Health care providers may limit care of overweight or obese children. The media promote weight bias in multiple ways. Some parents are biased against their obese children. In an effort to avoid weight bias, new efforts to reduce obesity must be evaluated to determine whether these efforts do, in fact, add to the problem. It is important to understand that the weight bias that obese youth face is just as serious as the physical consequences of excessive weight on the welfare of the child.     

Peer Reviewed: Internet-Based Morbidity and Mortality Surveillance Among Hurricane Katrina Evacuees in Georgia

Introduction

The Internet has revolutionized the way public health surveillance is conducted. Georgia has used it for notifiable disease reporting, electronic outbreak management, and early event detection. We used it in our public health response to the 125,000 Hurricane Katrina evacuees who came to Georgia.

Methods

We developed Internet-based surveillance forms for evacuation shelters and an Internet-based death registry. District epidemiologists, hospital-based physicians, and medical examiners/coroners electronically completed the forms. We analyzed these data and data from emergency departments used by the evacuees.

Results

Shelter residents and patients who visited emergency departments reported primarily chronic diseases. Among 33 evacuee deaths, only 2 were from infectious diseases, and 1 was indirectly related to the hurricane.

Conclusion

The Internet was essential to collect health data from multiple locations, by many different people, and for multiple types of health encounters during Georgia''s Hurricane Katrina public health response.     

Peer Reviewed: Dietary Practices, Dining Out Behavior, and Physical Activity Correlates of Weight Loss Maintenance

Introduction

Loss of excess weight can improve blood lipids, insulin sensitivity, and blood pressure. However, data are scant on behavioral strategies related to maintenance of weight loss. We examined dietary practices, physical activity, and self-efficacy among adults self-reported to be successful at maintaining weight loss.

Methods

Using the 2004 Styles survey, a mailed survey of U.S. adults aged 18 years or older, we examined behaviors associated with weight loss maintenance among people who reported trying to lose weight. We analyzed data on number of daily fruit and vegetable servings, minutes per week of physical activity, dining out behavior, and confidence in one''s ability to engage in behavioral strategies. We conducted frequency and multivariable logistic regression analyses.

Results

More men (35.5%) than women (27.7%) were classified as successful weight loss maintainers. Compared with adults who reported eating at a fast-food restaurant two or more times per week, adults who reported not eating at fast-food restaurants were more successful at weight loss maintenance (odds ratio, 1.62; 95% confidence interval, 1.09–2.42). Compared with adults who consumed fewer than five fruit and vegetable servings per day and were sedentary, adults who consumed fewer than five fruit and vegetable servings per day and accrued 420 minutes or more per week of physical activity or consumed five or more fruit and vegetable servings and accrued 150 minutes or more per week of activity were more successful at weight loss maintenance.

Conclusion

The behavioral strategy of reducing consumption of fast foods could assist people in keeping weight off. The combined approach of consuming five or more fruit and vegetable servings per day and attaining 150 minutes or more per week of physical activity was a common strategy among adults successful at weight loss maintenance.     

Peer Reviewed: An Intervention to Promote Healthy Weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) Theory and Design

Health professionals are faced with the growing challenge of addressing childhood overweight. Few overweight prevention efforts have targeted young children, particularly children in child care settings. We describe the theory and development of a novel nutrition and physical activity environmental intervention. On the basis of findings from interviews and focus groups, a review of national recommendations and standards, and a review of the literature, we developed a nutrition and physical activity environmental self-assessment instrument to assess physical activity and nutrition policies and practices in child care settings. An intervention model was built around existing public health infrastructure to support use of the self-assessment instrument and encourage environmental changes at the child care level, and this intervention model became the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program. The NAP SACC program was designed for dissemination and has potential for implementation in many settings. Broad interest in NAP SACC has been expressed by a number of states and institutions, and many groups are using NAP SACC intervention and materials. The NAP SACC program shows promise as a useful approach to promoting healthy weight behaviors in child care settings.     

Peer Reviewed: Using the RE-AIM Framework to Evaluate a Physical Activity Intervention in Churches

Introduction

Health-e-AME was a 3-year intervention designed to promote physical activity at African Methodist Episcopal churches across South Carolina. It is based on a community-participation model designed to disseminate interventions through trained volunteer health directors.

Methods

We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate this intervention through interviews with 50 health directors.

Results

Eighty percent of the churches that had a health director trained during the first year of the intervention and 52% of churches that had a health director trained during the second year adopted at least one component of the intervention. Lack of motivation or commitment from the congregation was the most common barrier to adoption. Intervention activities reached middle-aged women mainly. The intervention was moderately well implemented, and adherence to its principles was adequate. Maintenance analyses showed that individual participants in the intervention''s physical activity components continued their participation as long as the church offered them, but churches had difficulties continuing to offer physical activity sessions. The effectiveness analysis showed that the intervention produced promising, but not significant, trends in levels of physical activity.

Conclusion

Our use of the RE-AIM framework to evaluate this intervention serves as a model for a comprehensive evaluation of the health effects of community programs to promote health.     

Peer Reviewed: Effect of Socioeconomic Status on Weight Change Patterns in Adolescents

Introduction

Although socioeconomic differences in prevalence of obesity are well documented, whether patterns of weight gain during key periods of growth and development differ among youth from different socioeconomic backgrounds is unknown. This study examines socioeconomic disparities in overweight status and 5-year weight gain among adolescents.

Methods

Project EAT (Eating Among Teens)-II followed a socioeconomically and ethnically diverse sample of 2,516 adolescents from 1999 through 2004. Mixed-model regression analyses examined longitudinal trends in overweight status as a function of socioeconomic status (SES).

Results

Girls and boys in the low-SES category were more likely to be overweight than were those in the high-SES category. Boys in the high-SES category showed a significant decrease (P = .006) in overweight prevalence between 1999 and 2004, whereas boys in the low- and middle-SES categories showed no significant change. Girls in the low-SES category showed a significant 5-year increase (P = .004) in overweight prevalence compared with a stable prevalence of overweight among girls in the middle- and high-SES categories.

Conclusion

Our data show continued and, in some cases, increasing socioeconomic disparities in risk for overweight. Youth from low-SES backgrounds are at increased risk for overweight and are more likely to remain overweight (boys) or become overweight (girls). Designing obesity prevention and treatment interventions that reach and address the unique needs of youth and families from less-advantaged socioeconomic backgrounds is a public health priority.     

The Gut Microbiota during a Behavioral Weight Loss Intervention

Altered gut microbiota has been linked to obesity and may influence weight loss. We are conducting an ongoing weight loss trial, comparing daily caloric restriction (DCR) to intermittent fasting (IMF) in adults who are overweight or obese. We report here an ancillary study of the gut microbiota and selected obesity-related parameters at the baseline and after the first three months of interventions. During this time, participants experienced significant improvements in clinical health measures, along with altered composition and diversity of fecal microbiota. We observed significant associations between the gut microbiota features and clinical measures, including weight and waist circumference, as well as changes in these clinical measures over time. Analysis by intervention group found between-group differences in the relative abundance of Akkermansia in response to the interventions. Our results provide insight into the impact of baseline gut microbiota on weight loss responsiveness as well as the early effects of DCR and IMF on gut microbiota.     

Peer Reviewed: Strategies for and Barriers to Managing Weight When Eating at Restaurants

Introduction

Eating in restaurants contributes to excess caloric intake, which leads to weight gain, but little is known about strategies used to manage weight or barriers to weight management in restaurant settings. We describe and compare the strategies men and women use and the barriers they encounter when eating at restaurants.

Methods

We recruited a convenience sample of 146 adults at a university open house. Participants completed questionnaires on demographics and eating patterns, strategies used to manage weight in restaurants, and barriers to managing weight in restaurants.

Results

The most common strategies used by participants were avoiding sugar-filled drinks, choosing steamed vegetables and whole-grain foods, and stopping eating when full. We found few differences by sex: women were more likely to share appetizers or meals, substitute appetizers for meals, have salads as entrées, order salad dressing on the side, and bring half of the meal home.

Conclusion

Women and men had more similarities than differences in strategies for and barriers to managing weight in restaurants. We need to understand what influences food choices at restaurants in order to develop comprehensive plans for weight management.     

Peer Reviewed: Optimized Probability Sampling of Study Sites to Improve Generalizability in a Multisite Intervention Trial

Introduction

Studies of type 2 translation, the adaption of evidence-based interventions to real-world settings, should include representative study sites and staff to improve external validity. Sites for such studies are, however, often selected by convenience sampling, which limits generalizability. We used an optimized probability sampling protocol to select an unbiased, representative sample of study sites to prepare for a randomized trial of a weight loss intervention.

Methods

We invited North Carolina health departments within 200 miles of the research center to participate (N = 81). Of the 43 health departments that were eligible, 30 were interested in participating. To select a representative and feasible sample of 6 health departments that met inclusion criteria, we generated all combinations of 6 from the 30 health departments that were eligible and interested. From the subset of combinations that met inclusion criteria, we selected 1 at random.

Results

Of 593,775 possible combinations of 6 counties, 15,177 (3%) met inclusion criteria. Sites in the selected subset were similar to all eligible sites in terms of health department characteristics and county demographics.

Conclusion

Optimized probability sampling improved generalizability by ensuring an unbiased and representative sample of study sites.