Trial of prevention and reduction of obesity through active living in clinical settings: a randomized controlled trial.

BACKGROUND: The efficacy of physical activity with a healthful diet to reduce obesity is established; however, little is known about the translation of effective lifestyle strategies for obesity reduction in primary care settings. METHODS: We assessed the effectiveness of a 2-year behaviorally based physical activity and diet program implemented entirely within clinical practices to reduce obesity. A total of 490 sedentary, obese adults were randomized to usual care (n = 241) or to the behavioral intervention (n = 249). The usual care group received advice from their physicians about lifestyle as a strategy for obesity reduction. The behavioral intervention included individual counseling from health educators to promote physical activity with a healthful diet. The primary outcome was change in waist circumference (WC). RESULTS: A total of 396 participants completed the trial (80.8%). A significant main effect was observed for WC change within the intervention compared with usual care (P < .001) that was sustained at 24 months (mean [SE], -0.9 [0.4] vs 0.2 [0.4] cm; P = .05). Secondary analyses revealed significant main effects for change in WC in men (P = .009) and women (P = .02). In men, the mean (SE) reduction in WC at 24 months was greater with behavioral intervention compared with usual care (-1.6 [0.6] vs 0.1 [0.6] cm; P = .049). In women, the behavioral intervention was associated with differences in WC compared with usual care at 6 and 12 months (P ≤ .01) but not at 24 months (P = .10). CONCLUSIONS: Behavioral intervention in clinical settings is associated with modest reductions in WC during a 2-year study in obese patients. However, the effectiveness of the intervention is restricted to men. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00665158.

Readiness to shop for low-fat foods: a population study.

BACKGROUND: Stages of change are related to dietary fat consumption. Few studies have examined stage occupation within the context of purchasing low-fat foods. OBJECTIVE: To determine the stage-prevalence of individuals for purchasing low-fat foods; identify the frequency of misclassification into action and maintenance (A/M) stages for purchasing for low-fat foods; and explain the demographic and cognitive-variable differences between pseudo (or false positive) A/M and true A/M individuals. DESIGN: Data were collected using a self-administered questionnaire among English-speaking adults (n=1,001) who were randomly sampled by mail. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to compare the characteristics of the stage groups. Groups were compared using chi(2) tests and Student t test. RESULTS: Of those who reported being in A/M stages, 32% were misclassified by the staging algorithm and were not true A/M low-fat food purchasers. CONCLUSIONS: Individuals who are in A/M stages for buying low-fat foods still purchase high-fat foods. Stage misclassification may be a persistent problem in studies of dietary change using the Transtheoretical Model.

Applying the stages of change to multiple low-fat dietary behavioral contexts. An examination of stage occupation and discontinuity.

Consuming a diet lower in total fat is important for the prevention of many chronic diseases. Individual and population-based programs targeting this behavior must be theoretically grounded and consider the context within which dietary behavior change may be attempted. To identify the factors differentiating stage of readiness to follow a low-fat diet, a sample (N=1216) of adults was surveyed using 4 different staging algorithms to assess stages of change and associated social-cognitive variables (pros, cons, and temptation). Approximately 75% of the sample occupied the Action/Maintenance stages for all staging algorithms. In general, pros increased and cons decreased with higher stage occupation. Temptation decreased from the early pre-action to the action stages for the different staging algorithms. When developing programs to decrease dietary-fat intake, social-cognitive variables associated with stage transition for behaviors related to consuming a low-fat diet may have relevance to researchers and clinicians.

Development and evaluation of patient-centered software for a weight-management clinic.

OBJECTIVE: To describe a weight-management clinic software system and to report on its preliminary evaluation. RESEARCH METHODS AND PROCEDURES: The software system standardizes the collection of relevant patient information from an initial medical assessment, weekly clinic visits, and laboratory testing protocol of a medically supervised proprietary meal-replacement program in a university-based referral clinic. It then generates monthly patient feedback reports with graphs of clinical and laboratory parameters to support a patient-centered approach to weight management. After patients and clinic physicians review the data to ensure accuracy, the database is used for subsequent patient feedback reports, reports to referring physicians, quality assurance, and research. Clinic physicians and referring physicians were asked to rate their acceptance of the system. In addition, in a retrospective analysis of data generated by the system, outcomes for patients who received system-generated feedback (n = 620) were compared with those who participated in the program before the introduction of feedback (n = 130). RESULTS: Clinic and referring physicians reported that they had high overall satisfaction with the software and that the system saved them time, and the latter group reported that it decreased laboratory use. Regarding patients, the feedback group had lower dropout rates in the latter half of the program, better rates of attendance, completion of laboratory tests, and weight loss after 8 weeks. DISCUSSION: The software seems to facilitate the effectiveness of the treatment protocol for obesity and generates a high-quality database for patient care, clinic administration, quality assurance, and research purposes.