Feasibility of the flipped classroom approach for health education in a clinical weight loss program.

Aim: To assess the feasibility of the flipped classroom pedagogy in a clinical weight loss program and its impact on 6-month weight change. Methods: Adults with overweight/obesity enrolled in a 6-month program with a structured diet (portion-controlled meals and fruits/vegetables) and exercise plan (≥150mins/week), plus weekly, 1-h group education sessions. Sessions used a flipped classroom approach: educational content was delivered beforehand via podcast/video and book readings and session time involved application-based activities (e.g., case studies, games). Satisfaction surveys were completed at 3 months. Weight change was assessed using paired t-tests (SAS 9.4, significance 0.05). Results: Eighteen participants completed 6 months (retention 94%). Participants maintained diet adherence and exercise at 3 months (∼84% diet adherence, ∼153mins exercise/week) and 6 months (∼83% diet adherence, ∼158mins exercise/week), as well as attendance to behavioral sessions (3 months: 77%; 6mo: 71%). Satisfaction surveys showed high program enjoyment (∼8.1/10). Mean weight change at 3 and 6 months was -6.5 ± 4.2% and - 9.3 ± 5.0% (both p < 0.01), respectively. Conclusion: The flipped classroom pedagogy was feasible for delivery in a clinical weight loss program and supported significant 6-month weight loss. Innovation: This is the first evaluation of the flipped classroom in a clinical setting and supports the investigation of this pedagogy in weight management.

Motivational interviewing for weight management among college students during COVID-19: An exploratory randomized controlled trial.

Background: College students encounter challenges in managing their weight. The Coronavirus Disease 2019 (COVID-19) pandemic exacerbated the problem. The purpose of this study was to determine the effect of a motivational interviewing (MI) intervention compared to online education (control) on body composition and self-determination theory constructs among college students with overweight. Methods: This was a randomized clinical trial of 40 college students comparing an MI versus a control group. The MI group received monthly interviews: three face-to-face interviews before the pandemic, and three video chat interviews after the outbreak of COVID-19 spanning a total of six months. The control group received six, monthly education modules. Body composition was measured by the iDexa and self-determination theory (SDT) variables were assessed with surveys. Results: Mixed ANOVAs from pre-post revealed significant changes in fat mass (p = .03, η2 = 0.22), lean mass (p < .05, η2 = 0.18), body fat percentage (p < .01, η2 = 0.37), autonomy (p < .01, η2 = 0.38), relatedness (p < .01, η2 = 0.41), amotivation (p = .01, η2 = 0.29), external regulation (p = .02, η2 = 0.23), identified regulation (p = .02, η2 = 0.25), integrated regulation (p < .00, η2 = 0.49), and intrinsic regulation (p = .01, η2 = 0.27). Conclusions: In this exploratory analysis, MI demonstrated a positive trend in body composition maintenance when compared to online education among overweight college students during a national pandemic. Future studies utilizing MI would enhance the literature by further investigating the relationship between MI and SDT and measuring body composition.Clinicaltrials.gov. identifier: NCT04130386.

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

BACKGROUND: Parents 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. OBJECTIVE: To 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. METHODS: We 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. RESULTS: Data 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. CONCLUSION: We 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 NUMBER: NCT02561754.

How Teacher Verbal Prompting and Demonstrated Modeling Correlate to Preschooler's Physical Activity Levels.

BACKGROUND: Teacher-led strategies targeting verbal prompting and demonstrated modeling can increase preschoolers' physical activity levels; however, it is unknown which strategy promotes higher levels. The purpose of this study was to explore whether teacher verbal prompting or demonstrated modeling elicits higher levels of physical activity among preschoolers. METHODS: Participants included 117 (56 females and 61 males; mean = 3.77 y) preschoolers who were observed for 3 days during regular preschool instructions. The System for Observing Student Movement in Academic Routines and Transitions observation system assessed verbal prompting and demonstrated modeling of the teachers, and preschoolers wore an ActiGraph accelerometer to measure physical activity. RESULTS: The multivariate analysis of variance results showed a significant difference for verbal prompting (P < .001), demonstrated modeling (P = .032), light physical activity (P < .001), and moderate to vigorous physical activity (MVPA; P < .001) between segments of the preschool day. A stepwise linear regression showed that preschooler's MVPA (P = .005) and light physical activity and MVPA (P = .036) were significantly related to demonstrated modeling, but not verbal prompting. During indoor time, light physical activity and MVPA were highest during large group, work time, and morning group, where teacher demonstrated modeling occurred the most. CONCLUSIONS: Teacher demonstrated modeling had a significant relationship to preschoolers' MVPA and light physical activity levels, while teacher verbal prompting did not.

Concurrent Exercise Training: Long-Term Changes in Body Composition and Motives for Continued Participation in Women with Obesity.

The purpose of this project was to examine the effect of a concurrent exercise program (sprint interval training and resistance exercise) on body composition in women with obesity and factors associated with continued exercise participation following the program. Twenty women (37.1 ± 7.4 y, height = 1.63 ± 0.09 m, weight = 98.22 ± 0.22 kg, BMI = 34.2 ± 2.50 kg/m2) participated in a 10-week exercise intervention consisting of a sprint interval treadmill protocol and resistance training three times a week totaling 30 sessions. Body composition was measured by dual-energy X-ray absorptiometry (iDXA) at pretest, 12 weeks, and six months post-intervention. Semi-structured interviews assessed participants' perception of the program at both 12 weeks and six months. Participants significantly reduced fat mass (p < 0.001), gynoid fat mass (p < 0.010), android fat mass (p = 0.003), and visceral fat mass (p = 0.003) at 12 weeks post-test. At six months, participants maintained their reductions in fat mass (p = 0.015), visceral fat (p = 0.040) and gynoid fat mass (p = 0.032). There were no significant main time effects in lean mass (p = 0.099) or caloric intake (p = 0.053) at 12 weeks or six months. Themes that emerged from the semi-structured interviews at 12 weeks reflected enjoyment in the training, increases in competence and knowledge, as well as apprehension of continuing training on their own. At six months, themes that emerged reflected overcoming barriers, competence regarding high-intensity training, and a lack of competence to engage in resistance training. Sprint interval training coupled with resistance training is a feasible exercise protocol for women with obesity and results in reduced fat mass over six months. Improving women's competence for training is imperative for continued participation.

Weight loss in adolescents with down syndrome compared to adolescents with other intellectual disabilities enrolled in an 18-month randomized weight management trial.

Background: There is limited information on the efficacy of weight management interventions in adolescents with Down Syndrome (DS). Objective: To compare weight change and intervention compliance between adolescents with DS compared to adolescents with non-DS related intellectual disabilities (ID) who were enrolled in an 18-month weight management trial. Methods: Participants were adolescents (13-21 years) with mild to moderate ID and overweight or obesity. Participants were randomized in a 1:1:1 allocation to one of 3 intervention arms for an 18-month weight management trial: face-to-face/conventional diet (FTF/CD), remote delivery/conventional diet (RD/CD), or remote delivery/enhanced Stop Light Diet (RD/eSLD). Anthropometrics were assessed at baseline 6, 12, and 18 months by staff blinded to the intervention, and self-monitoring data was collected across the 18-month study. As an unpowered, post-hoc, secondary analysis, two-sample t-tests were used to compare the weight change across 6,12, and 18 mos. and compliance across 18 mos. between adolescents with and without DS randomized to each intervention arm. Results: Adolescents with ID (n = 110) were randomized to one of three intervention arms: FTF/CD (n = 36, DS = 17, other ID = 19), RD/CD (n = 39, DS = 21, other ID = 18) or RD/eSLD (n = 35, DS = 15, other ID = 20). Body weight at 18 months was obtained from 82%, 76% and 73% of participants with DS and 84%, 83% and 75% of participants with other ID randomized to the FTF/CD, RD/CD, and RD/eSLD arms, respectively Weight change across 18 months was -0.2 ± 8.8 kg (-0.5%), -0.3 ± 5.3 kg (-0.7%), and -2.6 ± 5.0 kg (-4.0%) in adolescents with DS randomized to the FTF/CD, RD/CD and RD/eSLD arms, respectively. There were no significant differences in change in body weight or BMI across 18 months between adolescents with DS or those with other ID in any of the 3 intervention arms (all p > 0.05). Additionally, there were no significant differences in intervention compliance between adolescents with and without DS across 18 mos. (all p > 0.05). Conclusions: Adolescents with DS respond to a multi-component weight management intervention similar to those with others ID.

Feasibility and Comparative Effectiveness for the Delivery of the National Diabetes Prevention Program through Cooperative Extension in Rural Communities.

The U.S. Cooperative Extension Service (CE) has potential to deliver the National Diabetes Prevention Program (NDPP) to rural residents with prediabetes. However, the CE remains underutilized for the delivery of NDPP. We compared the feasibility/effectiveness of the NDPP (0-6 mos.) delivered by CE personnel to rural residents with prediabetes using Zoom® (CE-Zoom®) or by our research staff using Facebook® (FB). Adults (n = 31, age ~55 years) were enrolled (CE-Zoom® n = 16, FB n = 15). Attendance did not differ significantly between groups (CE Zoom® = 69%, FB = 83%, p = 0.15). Participant retention was similar in the CE Zoom® (88%) and FB groups (87%). CE-Zoom® and FB® groups provided weekly, self-monitoring data for 83% and 84% of the 24 potential weeks, respectively. Six-month weight loss was not different between groups (CE-Zoom® = -5.99 ± 8.0 kg, -5.4%, FB = -1.68 ± 3.3 kg, -1.6% p = 0.13). Participants achieving ≥5% weight loss was greater in the CE-Zoom® (44%) compared with the FB group (7%, p = 0.04). Participants achieving the NDPP program goal for physical activity (≥150 min/week) did not differ (CE-Zoom® = 75%, FB = 67%, p = 0.91). This pilot trial demonstrated the potential feasibility and effectiveness of the NDPP delivered by CE personnel in a group remote format (Zoom®) to adults with prediabetes living in rural areas.

Impact of motivational interviewing as a follow-up to an exercise intervention among women with or at risk for metabolic syndrome: A randomized controlled trial.

OBJECTIVES: Women have a higher prevalence of metabolic syndrome than their male counterparts, and interventions should target women with or at risk for metabolic syndrome. The objective of this study was to compare two intervention strategies on long-term outcomes following the completion of an exercise intervention. METHODS: Twenty-six women (M age = 43.35 ± 9.03) with at least one risk factor for metabolic syndrome were randomized into either a motivational interviewing group (n = 10) or self-regulation-based mobile messaging control group (n = 16) as a 12-week follow-up to a 10-week, 30-session exercise intervention. Outcomes of interest were body fat percentage, bone mineral density, waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, high-density cholesterol, and fasting blood glucose. RESULTS: Mixed ANOVAs revealed a significant effect for group × time for body fat percentage F(1, 24) = 8.30, p = 0.01, η p 2 = 0.26, bone mineral density F(1, 24) = 6.68, p = 0.02, η p 2 = 0.22, waist circumference F(1, 24) = 10.35, p = 0.01, η p 2 = 0.30, triglycerides F(1, 24) = 5.06, p = 0.03, η p 2 = 0.17, and systolic blood pressure F(1, 24) = 5.39, p = 0.03, η p 2 = 0.18 all in favor of the motivational interviewing group after 12 weeks when compared to the self-regulation-based mobile messaging group. No significant effect for group × time was noted for diastolic blood pressure p = 0.36, η p 2 = 0.04, high-density cholesterol p = 0.08, η p 2 = 0.12, or fasting blood glucose p = 0.85, η p 2 = 0.01 when comparing the motivational interviewing and self-regulation-based mobile messaging groups. CONCLUSIONS: Motivational interviewing may be a more impactful solution to extend the effects of exercise intervention studies compared to a self-regulation-based mobile messaging control group. Future interventions should focus on increasing sample size, utilizing more objective measures of body composition, utilizing booster sessions, and increasing the length of follow-up periods.

Motivational Interviewing for Weight Management Among Women: a Meta-Analysis and Systematic Review of RCTs.

BACKGROUND: Motivational interviewing (MI) is a communication skill set used by clinicians to help facilitate adherence to numerous health behaviors. Currently, MI's evidence supports its use among adults in various realms; however, clarity is needed regarding weight management among females. The purpose of this systematic review and meta-analysis is to synthesize the literature examining the use of MI and its impact on anthropometric measures among adult females. METHOD: The authors conducted a modified Cochrane method of systematic search and review in several relevant databases to explore and report evidence and gaps in the literature for MI in weight management among females in addition to meta-analyses for weight and BMI. Criteria for retention included randomized controlled trials with open inclusion of studies with varied settings, methods, interventionists, target behaviors, and outcomes. RESULTS: Of the 3289 references initially identified, 10 intervention arms met the criteria across review tiers. Seven of 10 intervention groups reported significant anthropometric changes compared with a control group, as well as significant changes in non-anthropometric outcomes related to weight management. Using a random-effects model, the effect size of MI on reduction in body weight (kg) was 0.19 (95% CI - 0.13, 0.26; p < 0.01), and the effect size of MI on reduction in BMI was 0.35 (95% CI 0.12, 0.58; p < 0.01). CONCLUSIONS: Results suggest that MI interventions are useful for weight management among females. Future studies would enhance the current base of literature by utilizing advanced anthropometric outcomes, including sex-specific results, and including more diverse and larger sample sizes.

Motivational Interviewing for Overweight Children: A Systematic Review.

CONTEXT: Motivational interviewing (MI) is a communication method to help facilitate adherence to health behaviors through a series of person-centered strategies. MI's evidence base supports its use as a potential intervention strategy at the parental decision-maker level to impact young children's lifestyle behaviors to address childhood obesity; however, clarity is needed on the literature. OBJECTIVE: The purpose of this systematic review is to synthesize the literature examining the use of MI at the parental level to impact young children's weight status. DATA SOURCES: A modified Cochrane method of systematic search and review was conducted in several databases (eg, PsycINFO, Academic Search Premier, Medline, Cumulative Index to Nursing and Allied Health Literature, Health Source: Nursing/Academic Edition, and SPORTDiscus). STUDY SELECTION: Criteria for retention included randomized controlled trials and studies using varied settings, methods, interventionists, target behaviors, and outcomes. DATA EXTRACTION: Extraction domains included study characteristics and risk of bias. RESULTS: Of the 352 references initially identified, 7 studies were included in the review. In most studies, authors reported significant anthropometric changes as well as significant changes in nonanthropometric outcomes related to weight management compared to usual care. LIMITATIONS: The heterogeneity of the included studies and lack of comparison with attention control groups may cloud generalizations. Studies not written in English were excluded, possibly biasing the results. CONCLUSIONS: MI, compared to usual care, revealed positive effects for parent influence on young child anthropometric measures when applied. Future research should be focused on sample diversity, using attention control groups, using exercise physiologists for MI delivery, and reporting sex-specific results.