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Aims: Telehealth became a patient necessity during the COVID pandemic and evolved into a patient preference in the post-COVID era. This study compared the % total body weight loss (%TBWL), HbA1c reduction, and resource utilization among patients with obesity and diabetes who participated in lifestyle interventions with or without telehealth. Method(s): A total of 150 patients with obesity and diabetes who were followed every 4-6 weeks either in-person (n = 83) or via telehealth (n = 67), were included. All patients were provided with an individualized nutritional plan that included a weight-based daily protein intake from protein supplements and food, an activity/sleep schedule-based meal times, and an aerobic exercise goal of a 2000-calorie burn/week, customized to patient's preferences, physical abilities, and comorbidities. The goal was to lose 10%TBWL. Telehealth-based follow-up required transmission via texting of weekly body composition measurements and any blood glucose levels below 100 mg/dl for medication adjustments. Weight, BMI, %TBWL, HbA1c (%), and medication effect score (MES) were compared. Patient no-show rates, number of visits, program duration, and drop-out rate were used to assess resource utilization based on cumulative staff and provider time spent (CSPTS), provider lost time (PLT) and patient spent time (PST). Result(s): Mean age was 47.2 +/- 10.6 years and 74.6% were women. Mean Body Mass Index (BMI) decreased from 44.1 +/- 7.7-39.7 +/- 6.7 kg/m2 (p < 0.0001). Mean program duration was 189.4 +/- 169.3 days. An HbA1c% unit decline of 1.3 +/- 1.5 was achieved with a 10.1 +/- 5.1%TBWL. Diabetes was cured in 16% (24/150) of patients. %TBWL was similar in regards to telehealth or in-person appointments (10.6% +/- 5.1 vs. 9.6% +/- 4.9, p = 0.14). Age, initial BMI, MES, %TBWL, and baseline HbA1c had a significant independent effect on HbA1c reduction (p < 0.0001). Program duration was longer for in-person follow-up (213.8 +/- 194 vs. 159.3 +/- 127, p = 0.019). The mean annual telehealth and in-person no-show rates were 2.7% and 11.2%, respectively (p < 0.0001). Mean number of visits (5.7 +/- 3.0 vs. 8.6 +/- 5.1) and drop-out rates (16.49% vs. 25.83%) were lower in telehealth group (p < 0.0001). The CSPTS (440.4 +/- 267.5 min vs. 200.6 +/- 110.8 min), PLT (28.9 +/- 17.5 min vs. 3.1 +/- 1.6 min), and PST (1033 +/- 628 min vs. 113.7 +/- 61.4 min) were significantly longer (p < 0.0001) for the in-person group. Conclusion(s): Telehealth offered comparable %TBWL and HbA1c decline as in-person follow-up, but with a shorter follow-up, fewer appointments, and no-shows. If improved resource utilization is validated by other studies, telehealth should become the standard of care for the management of obesity and diabetes.Copyright © 2023 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.
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Objective: The COVID-19 pandemic has been shown to be negatively associated with physical activity engagement, adherence to healthy diet, and weight management among people with obesity. The current study examined COVID-19-related changes in weight, physical activity (PA), and diet among employees with obesity or overweight who participated in Vibrant Lives (VL), a worksite weight loss program. Methods: School district employees participated in the 6-month VL weight loss program and were categorized into non-COVID-era participants and COVID-era participants. Participants completed questionnaires about PA and dietary intake at baseline and follow-up. COVID-era participants reported the effects of pandemic on their behaviors. Changes in weight, PA, and diet were compared between groups using multilevel linear mixed models and logistic regression models. Results: A total of 266 participants (non-COVID, n=173; COVID, n=93) were included. Significant weight loss (non-COVID, -2.3 kg vs. COVID, -1.3 kg) and increases in moderate-to-vigorous PA minutes (non-COVID, 48.7 min vs. COVID, 61.5 min) were observed associated with the program, but no significant differences in changes between the groups were found. Compared to non-COVID participants, COVID participants decreased fast food consumption (P=.008) and increased sugar-sweetened beverage intake (P=.016). Higher frequency of snacking and overeating were reported as barriers to a healthy diet. Conclusion: The COVID-19 pandemic was negatively associated with healthful dietary behaviors. The information obtained from participants regarding the reasons for their pandemic-related changes in diet may help identify strategies to encourage healthier behaviors and weight management among people who have been negatively affected by the COVID-19 pandemic.This article is protected by copyright. All rights reserved.
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Objectives: Obesity is an epidemic in gynecologic oncology, leading to an increased risk of surgical complications and poor cancer outcomes. Cognitive-behavioral therapy (CBT) is an effective weight loss strategy. We aimed to determine whether group CBT is an effective weight loss tool when offered in an outpatient gynecologic oncology setting. Methods: We established a CBT-based weight management intervention for gynecologic oncology patients at an NCI-designated cancer center. The intervention was a 12-week group-based weight loss program offered to patients from the gynecologic oncology clinic with body mass indices (BMI) between 25-50 kg/m2. Sessions were free of charge, led by a psychologist and dietitian, and transitioned from in-person to tele-visits due to the COVID-19 pandemic. The program combined nutritional education, lifestyle changes, and CBT approaches, with 12 weekly group visits followed by three monthly individual follow-up visits. Each participant was given a goal weight loss of 7% total body weight (TBW). Retrospective data were collected from patients enrolled in the intervention from September 2019 through March 2021. Paired t-tests were performed to compare the pre-program and ending weights for all participants. Weight loss data were tested for normality using the Shapiro-Wilk test. Results: A total of 29 patients were enrolled in four cohorts during the study timeframe. Fifty-nine percent of participants were White, 38% were Black. The mean age among participants was 56 years, and the mean BMI was 41 kg/m2. Most participants had a history of endometrial hyperplasia or malignancy (58%) and had stage I disease (59%). Among the participants, 22 (76%) completed the program. The average weight loss among all participants during the 12-week program was 5.6 pounds (CI: -8.9- -2.1, p = 0.002), equivalent to an average 2% change in TBW. Among the 22 participants who completed the program, the average weight loss was 7.4 pounds (CI: -11.1- -3.8, p <0.001), equivalent to an average 3% change in TBW. Weight loss was sustained at the 6-month mark, with an average change in TBW of 2-3% when comparing weight at 6 months to pre-program weight. Conclusions: This CBT-based weight loss intervention was feasible and acceptable to gynecologic oncology patients. While the average weight loss fell short of the goal of 7% TBW, the 2-3% change in TBW achieved on average with this intervention was stable over six months. Additionally, retention within the intervention was high and maintained during COVID-19 with tele-visits. Given that weight loss plateaued when transitioning from weekly to monthly sessions, our findings suggest that longer, more intensive treatment may be needed to promote sustainable weight loss among gynecologic oncology patients. Collaboration between psychologists, oncology dietitians, and gynecologic oncologists, with continued support for psychologists and dieticians at cancer centers, is critical to the success of such programs. CBT is a feasible behavioral intervention to add further multidisciplinary efforts to tackle the complexity of obesity in cancer survivors. [Formula presented]
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Functional weakness of the limbs has an uncertain prognosis and little chance of recovery. Obese people in precarious situations may succeed in losing weight through an intensive lifestyle-based weight loss program. In patients with gonarthrosis, physiotherapy may decrease pain and disability when compared to injected corticosteroids. Patients suffering from an alcohol dependence syndrome can reduce their consumption with short-term consultations conducted by general practitioners. Fatigue and dyspnea are two frequent symptoms that may persist after the acute phase of the SARS-CoV-2 infection. PCR analysis for the detection of SARS-CoV-2 could be performed with the same degree of sensitivity on a nasopharyngeal or salivary swab.
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Background: On October 2020 the Health and Labor Departments of Argentina decreed workers with BMI ≥ 40 kg / m2, a risk group for serious forms of COVID infection, had to suspend attendance at the workplace. On November 2020, a virtual multi-component intervention weight loss program was implemented for workers of an oil and gas company reached by the decree. The primary objective was to achieve significant weight loss to reduce health risks associated to obesity. The secondary objective was to achieve the return to work of the employees. Methods: 89 employees with grade 3 obesity from different areas of Argentina, including remote areas (Patagonia and Yungas -mountain jungle-), were invited to participate in a 3-month weight loss program. The program consisted in weekly virtual workshops on diet, physical activity and behavior change;plus telemedicine consultations based on motivational interview with physician, nutritionist, psychologist, and nurse. A cell phone app was designed to promote self-management of the disease: recording of weight progression, physical activity and meals. It also gave participants access to recorded weekly workshops, and a reservation system for appointments. Results: Average initial BMI was 46.03 kg/m2. After 3 months of intervention, 52 participants (58%) achieved a decrease in BMI < 40 kg/m2 and returned to work. 31.4% participants achieved a decrease of ≥5% and 23.6% of ≥10% of their initial weight. In the 6-month longitudinal follow-up, 66% of participants achieved BMI < 40 kg / m2. Conclusions: The context of the Covid 19 pandemic was an opportunity to install obesity as a disease in the workplace and increased awareness of employers and employees on health risks associated to it. The implementation of a structured virtual weight loss program on the workplace setting can be an effective obesity approach, including remote areas.
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Background: College students with overweight/obesity have reported low self-efficacy in meal preparation and an interest in participating in a culinary weight loss program. Interventions that target weight loss and culinary skills and adhere to COVID-19 social distancing guidelines are lacking. The primary objective of this study was to evaluate the feasibility of a 6-week, internet-based culinary behavioral weight loss program in undergraduates with overweight/ obesity. The secondary objectives were to evaluate changes in culinary outcomes, nutrition knowledge, weight and physical activity, and to assess facilitators and barriers to program adherence. Methods: NYU students with overweight/obesity participated in the 6-week Dietary Intervention and Culinary Education (DICE) program delivered via Zoom. DICE included evidence-based behavioral weight loss strategies, hands-on culinary activities, Instacart gift cards for groceries, weekly incentives and text messaging support. We used a one-group pretest-posttest design with a mixed-methods approach to assess feasibility (sample characteristics, recruitment, resources, program adherence), culinary, nutrition, weight, and physical activity outcomes, and to identify facilitators/barriers to adherence. Results: Participants (N = 26, BMI = 29.6 ± 4.6, age = 20 ± 1) were 69% female, 77% Non-Hispanic/ Latino, 31% Asian and 23% Black/ African-American. Recruitment by Zoom was most successful;39% indicated Zoom as their mode of recruitment. Total implementation cost was $5,797. Forty-eight percent of participants attended sessions and submitted goals for at least 4 of the 6 weeks (adherers). Perceived culinary skills/nutrition knowledge and cooking attitudes/self-efficacy increased and weight and sitting time decreased during the study (p <.05). Facilitators to adherence were optimal timing of sessions, cooking in their own kitchen, and accountability. Barriers were insufficient culinary equipment and time to submit goals/self-monitor, fast pace of culinary educator, desire for more grocery options, and inconvenient time. Conclusions: DICE is a low cost program that can improve culinary and weight outcomes and reduce sitting time. Recruitment efforts to increase diversity and additional culinary equipment, grocery choices and time should be incorporated into future programs.
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Background: Obesity is considered a risk factor for severe COVID-19 illness. Thus, individuals with obesity may be especially motivated to lose weight because of COVID-19. To our knowledge, this is the first study to assess COVID-related motivators to lose weight and whether they predict weight loss. Methods: In this prospective study, 530 new users of a digital commercial weight loss program completed a baseline survey in January 2021 assessing overall motivation to lose weight due to COVID (one item: 'how much of your interest in losing weight is because of COVID-19 or its impact, however minor, on your life?'), and three specific COVID motivators. These specific motivators were measured by the validated Fear of COVID-19 scale (F-C), one item assessing motivation to improve eating habits which got worse during COVID-19 (EH-C), and one item assessing motivation to prevent diseases that could increase COVID-19 risk (D-C). The main outcome was weight loss at 2 months, extracted from self-reported weight on the program. Results: Participants were 84% female, had a median age of 46, mean baseline BMI of 32.12 (SD = 6.96), and lost 3.13kg (3.49%) at 2 months (SD = 2.72kg). Overall COVID motivation was high;66% reported that their interest in losing weight was due to COVID. There was high F-C (M = 25.2 out of 35) and EH-C (M = 7.7 out of 10), and moderate D-C (M = 5.4 out of 10). Despite high COVID-related motivation, overall motivation, F-C, and EH-C did not predict weight loss at 2 months. D-C marginally significantly predicted weight loss at 2 months (B = -. 09, p = .06). Conclusions: Results suggest that even though individuals showed initial high motivation due to COVID, it did not manifest in actual weight loss, except in the most at-risk individuals who sought to prevent diseases that put them at greater risk. Individuals may need support to translate initial COVID-related motivation to actual weight loss. Next, we will examine relationships between COVID motivators, vaccination status, and weight loss at 4 months.
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Background: There is evidence that the social, economic and health burdens, including weight gain, of the COVID-19 pandemic, were greater in women than men. Most of the available data is observational in nature, and the influence of the pandemic on treatment programs is of importance, especially as it relates to gender. To our knowledge, no one has examined the impact of gender on weight loss program outcomes during the COVID-19 quarantine year (2020). Methods: In gender specific analyses, we examined program retention and weight loss across 20 weeks of an employer sponsored online behavior-based weight loss program (Wondr Health) during the time periods of 2019 (pre-covid) and 2020 (active pandemic). In 2019, the sample contained 80,998 participants (75.5% women) and 54,363 participants (73.4 %women) in 2020. We examined weekly weight loss as a percent as well as percent of the population that achieved at least 5% weight loss at some point in the program. Results: In neither, women nor men, was there a difference in weekly retention when comparing 2019 to 2020. For women, at every program week mean weight loss was less in 2020 compared to 2019. For example, cumulative weight loss at week 20 in 2019 was -5.1% (95% CI: 5.0%,5.1%) compared to 4.7% (4.6%,4.8%) in 2020 (p < 0.001). In contrast, men had no differences across the program weeks. For example, week 20 weight loss was 6.0% (5.9%,6.2%) in 2019 and 6.2% (6.0%,6.3%) (p = 0.15). In dichotomous analyses, women had a reduction in the percent that achieved at least 5% weight loss (19.6% vs 17.6%, p < 0.001) from 2019 to 2020, whereas men had not difference across the years (23.8% vs 24%, p = 0.6). Conclusions: Using an online, behavioral-based weight loss program, both genders had clinically meaningful weight loss during the COVID-19 period. And while there was statistically significant less weight loss in women during the COVID-19 time period, the clinical impact of this difference (0.4 kg) is questionable. Exploring the potential causes for the decrease in weight loss in women during the quarantine year are an important area of future analyses and work. We are currently cleaning the quality-of- life data to serve as the first place to start such analyses.
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INTRODUCTION: Lockdown due to the COVID-19 pandemic has caused gym closures and adjustments to ongoing weight loss programs were needed in order to keep the programs running. Little is known whether adjustments affected the success of weight reduction. Weight reduction of at least 5% is related to improved fertility and better pregnancy outcomes in obese women. This study compared success of the weight loss program in infertile polycystic ovary syndrome women with obesity who attended the program before and during lockdown due to COVID-19 pandemic. Furthermore, we checked whether there were any differences in spontaneous pregnancy rates between both groups at the end of the program. METHODS: Altogether, 27 women were prospectively included to the weight loss program. Twelve women attended the 8 - week program before COVID-19 pandemic. Fifteen women began the program before the lockdown and ended it during lockdown. Due to lockdown, the program was prolonged for 4 weeks and taken online. RESULTS: On average, prior to lockdown women achieved a BMI reduction of 6.8% whereas women that attended the program during the lockdown reduced their BMI for 3.7%. This difference was not statistically significant. No significant differences were seen in other measured anthropometric and endocrine parameters between both groups. Furthermore, there were no differences in spontaneous pregnancy rates between both groups. In women who reduced their BMI for 5% or more, spontaneous pregnancy rate was 29.4%. DISCUSSION/CONCLUSIONS: Although statistical significance has not been reached in the present study, we have shown that lockdown due to COVID-19 pandemic has led to almost half lower BMI reduction despite adaptations and longer duration of the weight loss program. On average, BMI in the group of women that attended the program during lockdown was 3.7% lower after the end of the weight loss program. This means they did not reach the wanted 5% reduction which is known to improve fertility. We have also shown that weight reduction is the correct approach for treating infertile women with obesity, as almost 30% of those who reduced their body weight by 5% or more conceived spontaneously.
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COVID-19 , Infertilidad Femenina , Síndrome del Ovario Poliquístico , Programas de Reducción de Peso , Control de Enfermedades Transmisibles , Femenino , Humanos , Infertilidad Femenina/terapia , Obesidad/complicaciones , Obesidad/epidemiología , Obesidad/terapia , Pandemias , Síndrome del Ovario Poliquístico/complicaciones , Síndrome del Ovario Poliquístico/epidemiología , Síndrome del Ovario Poliquístico/terapia , Embarazo , SARS-CoV-2RESUMEN
The aim of this study was to assess the impact of the nationwide total lockdown (LD) in France on weight loss and body composition modifications in subjects participating in a weight loss program and to evaluate the impact of remote consultations on participants' adherence to the weight loss program. The CO-RNPC study was a prospective multicentre cohort study including participants undergoing a two to six months program. The rate of weight loss in kg/week was computed before (15 days), during (99 days) and after LD (15 days). In the 1550 completing participants, body weight decreased from 87.1 kg [IQR 77.0; 100.2] to 82.3 kg [72.1; 94.3] resulting in a difference of -4.79 kg [-4.48; -5.10] (p < 0.01), with a corresponding reduction in waist circumference by 4 cm ([0; 9], p < 0.01). The median weight loss was 4.4 kg [0.5; 9.4] in those who used remote consultations, and 1.4 kg [0.8; 5.7] in the no remote consultation group (p < 0.01). In this large prospective cohort, we observed that the rate of weight loss was reduced during LD. This reduction was counterbalanced in participants involved in a remote consultation follow-up with a dose-effect response based on the number of remote consultations.