A Group Randomized Trial to Reduce Obesity among Appalachian Church Members: The Walk by Faith Study.

Background: Appalachia is a rural, socioeconomically disadvantaged region with high rates of cancer and obesity. Using community-based participatory research principles, the Appalachia Community Cancer Network tested an initiative to reduce weight among overweight and obese participants by partnering with churches, an important community-based institution in Appalachia.Methods: A group randomized trial was conducted with counties or groups of counties in five Appalachian states. These groups were randomly assigned to receive either monthly diet and exercise education sessions ("Walk by Faith"; WbF) or an educational program focused on cancer screening and education ("Ribbons of Faith"; RoF) to examine effects on weight change. Participants completed questionnaires and biometric measurements at baseline and 12 months. The primary outcome of the study was weight change from baseline to 12 months.Results: The relative difference in weight loss from baseline to 12 months for WbF compared with RoF was 1.4% but was not statistically significant (P = 0.13). However, results varied by sex and marital status. WbF men experienced a significant 2.8% decrease in body weight, married WbF women a 1.5% decrease, and unmarried WbF women a 1.5% increase compared with their respective RoF subgroups (interaction P = 0.016). Among WbF participants, greater participation in monthly educational sessions was associated with greater weight loss (P = 0.002).Conclusions: WbF facilitated weight loss mainly in male participants. Level of participation in WbF activities correlated with weight loss.Impact: Findings suggest that additional research is needed to better understand factors associated with participation in health promotion programs for underserved rural communities. Cancer Epidemiol Biomarkers Prev; 27(11); 1289-97. ©2018 AACR.

Pilot Investigation of 2 Nondiet Approaches to Improve Weight and Health.

Context • Weight loss and maintenance are associated with many health benefits, but long-term maintenance of weight loss remains elusive for many people. Overweight individuals are at higher risk than normal-weight individuals for stress-induced overeating. The use of stress-management tools in a weight loss program might decrease the physiological stress that fuels overeating and improve posttreatment maintenance of weight loss Objective • The study intended to compare the differences in outcomes between 2 approaches to achieving weight loss and changes in health-stress reduction and intuitive eating (IE)-during a 14-wk period. Design • The research team designed a small, randomized, controlled pilot study. Setting • The study took place at the University of Kentucky (Lexington, KY, USA). Participants • Men and women, aged 25 to 65 y, with a body mass index ≥30 but ≤40 kg/m2, were recruited through various outlets on a large college campus, and 33 enrolled in the study. Intervention • Participants were randomly assigned either to an IE or to a stress-reduction program (EBT) for a 7 wk intervention and a 7-wk follow-up period. Outcome Measures • Weight, blood pressure, stress, depression, and eating behaviors were measured at baseline, postintervention at week 7, and postintervention at week 14. Results • Participants were 69.7% female and 93.9% Caucasian. An intent-to-treat analysis was conducted on the main outcome of weight. At 14 wk, the EBT group had lost 4.4 ± 6.7 lb (1.99 ± 3.04 kg), and the IE group had lost 1.03 ± 6.10 lb (0.48 ± 2.77 kg). A repeated measures analysis of variance did not find any significant difference between groups for weight change (P = .36). Completers in the EBT group significantly improved blood pressure, perceived stress, and food addiction symptoms from baseline to 7 wk (P < .05). Only the changes in weight were maintained at 14 wk. Conclusions • The study suggested that the stress reduction approach may be viable as an approach to weight loss and improvements in health-related outcomes in the short term. A longer investigation of the program is warranted.

A comparison of a behavioral weight loss program to a stress management program: A pilot randomized controlled trial.

OBJECTIVES: This study compared a behavioral weight loss program (BWL) with a stress management-based program, Emotional Brain Training (EBT), on weight loss, blood pressure, depression, perceived stress, diet, and physical activity. METHODS: Subjects with a body mass index (BMI) of >28 and <45 kg/m(2) were recruited in Lexington, Kentucky in January 2014 and randomized to BWL or EBT for a 20-week intervention. Of those recruited, 49 participants were randomized to EBT or BWL. Randomization and allocation to group were performed using SPSS software. Weight, blood pressure, depression, perceived stress, dietary intake, and physical activity were measured at baseline, 10 week, and 20 week. Linear models for change over time were fit to calculate 95% confidence intervals of intervention effects. RESULTS: BWL produced greater changes in BMI than EBT at both 10 (P = 0.02) and 20 wk (P = 0.03). At 10 wk, both EBT and BWL improved BMI, systolic blood pressure, depression and perceived stress (P < 0.05). BWL also improved diastolic blood pressure (P = 0.005). At 20 wk, EBT maintained improvements in BMI, systolic blood pressure, depression, and perceived stress while BWL maintained improvements only in BMI and depression (P < 0.05). CONCLUSIONS: BWL produced greater weight loss than EBT; however, EBT produced sustained improvements in stress, depression, and systolic blood pressure. A combination of the two approaches should be explored.

A pilot Internet-based behavioral weight loss intervention with or without commercially available portion-controlled foods.

OBJECTIVE: To evaluate the short-term impact of portion-controlled food provision in combination with an Internet behavioral weight loss program on weight, blood cholesterol, and blood glucose levels. DESIGN AND METHODS: Fifty participants, mean age 46 ± 10.7 years and mean body mass index 35.1 ± 3.8 kg/m2 , were randomized to one of two study groups, an Internet behavioral weight loss program (Internet-alone; n = 25) or an Internet behavioral weight loss program plus a commercially available portion-controlled diet (Internet + PCD; n = 25) for 12 weeks. RESULTS: An intent-to-treat analysis found that the mean weight change in the Internet + PCD group was -5.7 ± 5.6 kg and in the Internet-alone group (n = 25) was -4.1 ± 4.0 kg (P = 0.26). Participants in the Internet + PCD group achieved significantly greater improvements in blood glucose (-2.6 ± 5.7 vs. 1.4 ± 11.0 mg/dl; P = 0.05) and LDL cholesterol (-8.2 ± 18.0 vs. -0.6 ± 21.0 mg/dl; P = 0.04), compared with Internet-alone group. CONCLUSIONS: These data suggest that there may be short-term clinical benefit in using a PCD in conjunction with a behavioral Internet-based weight loss program to enhance weight loss and improve health indicators.

Motivation and its relationship to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight loss intervention.

OBJECTIVE: To examine changes in motivation and the relationship of motivation to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight-loss intervention. DESIGN: Two-group randomized design. SETTING: This study was conducted over the Internet. PARTICIPANTS: Sixty-six women, ages 22-65, with a body mass index (BMI) between 25 and 40, and with a home computer with Internet access, participated. INTERVENTION: These data are from an Internet behavioral weight-loss program in which all participants received a face-to-face initial session followed by the 16-week Internet program. MAIN OUTCOME MEASURES: Adherence to self-monitoring and weight loss were the main outcome measures. ANALYSIS: Linear regression and mediation analysis using the Baron and Kenny method were conducted. RESULTS: Autonomous motivation increased initially and remained high for those who ultimately achieved a 5% weight loss, but declined over time for participants who did not achieve a 5% weight loss. Autonomous motivation at 4 weeks was a predictor of adherence to self-monitoring and 16-week weight loss. Adherence mediated the relationship between autonomous motivation and weight loss. CONCLUSIONS AND IMPLICATIONS: These results suggest that autonomous motivation may be a promising intervention target for promoting program procedure adherence and weight loss.

The effect of a motivational intervention on weight loss is moderated by level of baseline controlled motivation.

BACKGROUND: Clinic-based behavioral weight loss programs are effective in producing significant weight loss. A one-size-fits-all approach is often taken with these programs. It may be beneficial to tailor programs based on participants' baseline characteristics. Type and level of motivation may be an important factor to consider. Previous research has found that, in general, higher levels of controlled motivation are detrimental to behavior change while higher levels of autonomous motivation improve the likelihood of behavior modification. METHODS: This study assessed the outcomes of two internet behavioral weight loss interventions and assessed the effect of baseline motivation levels on program success. Eighty females (M (SD) age 48.7 (10.6) years; BMI 32.0 (3.7) kg/m(2); 91% Caucasian) were randomized to one of two groups, a standard group or a motivation-enhanced group. Both received a 16-week internet behavioral weight loss program and attended an initial and a four-week group session. Weight and motivation were measured at baseline, four and 16 weeks. Hierarchical regression analysis was conducted to test for moderation. RESULTS: There was significant weight loss at 16-weeks in both groups (p < 0.001); however there were no between group differences (p = 0.57) (standard group 3.4 (3.6) kg; motivation-enhanced group 3.9 (3.4) kg). Further analysis was conducted to examine predictors of weight loss. Baseline controlled motivation level was negatively correlated with weight loss in the entire sample (r = -0.30; p = 0.01). Statistical analysis revealed an interaction between study group assignment and baseline level of controlled motivation. Weight loss was not predicted by baseline level of controlled motivation in the motivation-enhanced group, but was significantly predicted by controlled motivation in the standard group. Baseline autonomous motivation did not predict weight change in either group. CONCLUSIONS: This research found that, in participants with high levels of baseline controlled motivation for weight loss, an intervention designed to enhance motivation for weight loss produced significantly greater weight loss than a standard behavioral weight loss intervention.

Towards a more comprehensive understanding of cancer burden in North Carolina: priorities for intervention.

OBJECTIVE: To apply 4 measures of population burden in examining cancer burden in North Carolina and to identify priorities for intervention. METHODS: Four measures were used: incidence, mortality, prevalence, and years of potential life lost (YPLL). The North Carolina Central Cancer Registry provided summary data on incidence and mortality and record-level data that were examined using SEER*Stat software to calculate prevalence. North Carolina vital statistics (mortality) data and life expectancy estimates stratified by age, race, and sex were used to calculate YPLL. Each cancer site was ranked according to burden for each of the 4 individual burden measures and summarized into an overall rank. Burden was examined overall and by sex and race. PRINCIPAL FINDINGS: Four cancers--lung/bronchus, female breast, prostate, and colon/rectum--accounted for approximately 57% of the total cancer incidence, prevalence, mortality, and YPLL in North Carolina. Patterns of burden in gender and race subgroups were similar, although non-whites often had higher mortality rates than did whites despite similar incidence rates. An estimated 207,583 people were living with cancer in 2004 Breast and prostate cancer accounted for 42% of these survivors. Lung/bronchus cancer was the most severe cancer, accounting for more deaths and years of life lost than any other 5 cancers combined. CONCLUSIONS: Each of the 4 measures provides unique insight and guidance for cancer coordination and control efforts. Lung/bronchus, female breast, prostate, and colon/rectum cancers accounted for the majority of North Carolina's cancer burden and should be priorities for intervention.

A randomized comparison of two motivationally enhanced Internet behavioral weight loss programs.

PURPOSE: Sixty-six women participated in this study, which compared two 16-week motivationally enhanced weight loss interventions. Both intervention groups, which are entitled "Minimal" and "Enhanced" throughout the description that follows, received a motivationally enhanced initial face-to-face weight loss session. The initial session was followed by a 16-week Internet behavioral weight loss program, which included a study website with weekly lessons, an online self-monitoring diary form, web links to related sites, and separate message boards. The Enhanced group also received weekly moderated online chat group sessions led using motivational techniques. RESULTS: Both groups lost weight over time (p<0.001), however the group by time interaction was non-significant (p=0.19). The Minimal group lost 5.22+/-4.72 kg and the Enhanced group lost 3.71+/-4.46 kg. In the Enhanced group, online chat session attendance averaged 8.0 of the 16 chats offered. Greater program utilization was associated with greater weight loss in both groups. CONCLUSIONS: The addition of weekly motivationally enhanced online chats did not increase weight loss in this study. Further research is needed on the type and frequency of group support that is most desirable and beneficial in Internet weight loss interventions and could also explore building motivation for program utilization.

The use of the pile sort method in identifying groups of healthful lifestyle behaviors among female community college students.

When encountering new or understudied populations, it is useful to build an understanding of the needs and perceptions of the target audience. This study investigated the application of the qualitative pile sort method for gaining information about nutrition and physical activity behaviors. In a pile sort, individuals make a list of topics relevant to a particular subject, and then they group these topics into related piles. This study investigated whether there was consistency in the ways in which participants grouped behaviors related to having a healthful lifestyle. Pile sorts were conducted during six focus groups among 28 female community college students (46% white; 39% had a 2-year degree or higher). A total of 74 piles of grouped behaviors were coded from the transcripts. Analyses revealed good consistency (identified nine to 12 times) for four groupings: exercise, lifestyle, how you eat, and positive foods. The pile sort method represents an activity that can be incorporated into formative research for interventions focused on complex behaviors with multiple components; in addition, this method may provide structure to counseling sessions and facilitate a better understanding of the perceptions of healthful eating and physical activity from patients' perspectives.

Motivational interviewing in internet groups: a pilot study for weight loss.

Motivational interviewing is a technique for developing and maintaining motivation. This pilot study examined the feasibility and acceptability of motivational interviewing in online weight-loss treatment groups. Twenty women participated in the 8-week minimal contact intervention, received weekly e-mailed lessons, and were randomized to two online groups using motivational interviewing, either with or without a discussion of values. Acceptability of format and content was measured following the second online group. Self-reported weight and motivation were measured at baseline and 8 weeks. Qualitative analysis of group transcripts examined self-motivational statements uttered by participants during online groups. Eighty-four percent of participants reported willingness to participate again and were comfortable with the discussion topics. The average number of self-motivational statements uttered by participants did not differ by group (P=0.85) and was correlated with an increase in autonomous motivation during the 8 weeks (r=0.58, P=0.05). Higher autonomous motivation at follow-up was associated with greater weight loss (r=0.51, P<0.05). This study suggests that motivational interviewing techniques are acceptable and may be useful for targeting and maintaining motivation in online weight-loss groups.

Extending the reach of nutrition education for older adults: feasibility of a Train-the-Trainer approach in congregate nutrition sites.

Low-income older adults are difficult to reach with nutrition education. This study examines the feasibility of a Train-the-Trainer approach using congregate nutrition site (CNS) managers to deliver nutrition education. The study suggests that CNS managers were receptive to the role of trainer, CNS participants were satisfied with this method, and the acceptability of managers as trainers did not vary with participants' levels of risk of malnutrition. Although the sample size (53 participants and 4 managers) and convenience sampling method limit generalizability, the promising results suggest the potential benefits of this method and the need for further study.