Amanda Lewis

Development and feasibility testing of a smart phone based attentive eating intervention

BackgroundAttentive eating means eating devoid of distraction and increasing awareness and memory for food being consumed. Encouraging individuals to eat more attentively could help reduce calorie intake, as a strong evidence base suggests that memory and awareness of food being consumed substantially influence energy intake.MethodsThe development and feasibility testing of a smartphone based attentive eating intervention is reported. Informed by models of behavioral change, a smartphone application was developed. Feasibility was tested in twelve overweight and obese volunteers, sampled from university staff. Participants used the application during a four week trial and semi-structured interviews were conducted to assess acceptability and to identify barriers to usage. We also recorded adherence by downloading application usage data from participants’ phones at the end of the trial.ResultsAdherence data indicated that participants used the application regularly. Participants also felt the application was easy to use and lost weight during the trial. Thematic analysis indicated that participants felt that the application raised their awareness of what they were eating. Analysis also indicated barriers to using a smartphone application to change dietary behavior.ConclusionsAn attentive eating based intervention using smartphone technology is feasible and testing of its effectiveness for dietary change and weight loss is warranted.

Regular self-weighing to promote weight maintenance after intentional weight loss: a quasi-randomized controlled trial

BACKGROUND Many overweight people take action to lose weight but most regain this weight. PURPOSE To examine the effectiveness of a weight maintenance intervention focused on regular self-weighing after receiving a 12-week weight loss programme. METHODS Quasi-randomized controlled trial of 3768 obese or overweight men and women. The intervention group (n = 3290) received two telephone calls, the offer of free weighing scales, encouragement to weigh themselves weekly and record this on a card. The main outcome was change in weight between 3 and 12 months. RESULTS Using intention to treat analysis both groups regained weight; however, the intervention group on average regained 1.23 kg, whereas the control group regained 1.83 kg. Adjusting for covariates resulted in a mean difference of 0.68 kg (95% CI 0.12, 1.24) at 12-month follow-up. CONCLUSIONS Encouraging people who have recently lost weight to weigh themselves regularly prevents some weight regain.

A randomised controlled trial to compare a range of commercial or primary care led weight reduction programmes with a minimal intervention control for weight loss in obesity: the Lighten Up trial

BackgroundDeveloped countries are facing a huge rise in the prevalence of obesity and its associated chronic medical problems. In the UK Primary Care Trusts are charged with addressing this in the populations they serve, but evidence about the most effective ways of delivering services is not available. The aim of this study is to determine the effectiveness of a range of weight loss programmes for obese patients in primary care and to determine the characteristics of patients who respond to an invitation to a free weight management programme.Methods/DesignLighten Up is a randomised controlled trial comparing a range of 12-week commercial and NHS weight reduction programmes with a comparator group who are provided with 12 vouchers enabling free entrance to a local leisure centre. The weight reduction programmes are: (i) Weight Watchers, (ii) Slimming World, (iii) Rosemary Conley, (iv) a group-based dietetics-led programme (Size Down), (v) general practice one-to-one counselling, (vi) pharmacy-led one-to-one counselling, (vii) choice of any of the 6 programmes. People with obesity or overweight with a co-morbid disorder are invited to take part by a letter from their general practitioner. The sample size is 740 participants.The primary outcome is weight loss at programme-end (3 months). Secondary outcomes are weight-loss at one year, self-reported physical activity at 3 and 12 months follow-up and percentage weight-loss at 3 months and one year.DiscussionThis trial will provide evidence about the effectiveness of a range of different weight management programmes in a primary care population.Trial registrationCurrent Controlled Trials ISRCTN25072883

Modelling effects of stair width on rates of stair climbing in a train station

OBJECTIVES Commuters leaving a station often choose the stair as a quicker exit than the escalator. This paper models the effects of speed leaving the station and stair width on choice of the stairs or escalator. METHODS Aggregated data from previous studies (n=82,347) revealed a plateau at about 45% stair use as the number leaving each train rose. Subsequently, the time taken by passengers on the stairs and escalator was measured in a station in Birmingham, UK in 2007 (n=5848). The resulting transport rates (passengers s(-1)) for stairs and escalators at the average commuting traffic were used to estimate the effects of increases in stair width on choice of the stairs. RESULTS Average transport rates were higher for the escalator (0.93+/-0.33 passengers s(-1)) than the stairs (0.58+/-0.24 passengers s(-1)). Modelling of the effects of transport rate with multiple regression suggested 40.1% of passengers would use the stairs, a figure close to the observed rate. Using similar calculations, a doubling of width of the stairs could result maximally in a 17.2% increase in stair use. CONCLUSIONS Changes to the width of stairs could produce a permanent increase in lifestyle physical activity immune to the effects of time on healthy intentions.

Prompt before the choice is made: Effects of a stair-climbing intervention in university buildings

OBJECTIVES   Recent interventions report positive results following a multi-component campaign to increase stair climbing. This study investigated the effectiveness of volitional and motivational components of a stair-climbing intervention in the workplace. Design.  Interrupted time-series design. METHODS   Ascending stair/lift choices, coded by gender, were observed between 08:00-10:00 and 14:15-16:15 on weekdays, in four university buildings (n = 14,138; 46% female). Baseline observations (stage 1; 5 days) preceded a motivational intervention, that is, a poster positioned inside the lift(s), that was positioned in each building (stage 2; 5 days). Next a volitional intervention, that is, point-of-choice prompt, supplemented the motivational one (stage 3; 8 days). Logistic regression analysis of stair/lift choices included the independent variables of intervention components, gender, time of day, building height, number of lifts, and pedestrian traffic. RESULTS   There was no significant change in stair climbing when the motivational component was positioned alone (Odds Ratio [OR] = 0.93, 95% Confidence Interval [CI] = 0.85-1.02, p = .123). In contrast, stair climbing increased significantly when the volitional component, that is, the point-of-choice prompt, was added (OR = 1.23, 95% CI = 1.14-1.32, p < .001). During both stages, building height, number of lifts, time of day, and pedestrian traffic were all associated with stair climbing. No significant gender effects were seen. CONCLUSIONS   A motivational component positioned alone, inside the lift(s) did not increase stair climbing. When a volitional component was added, that is, point-of-choice prompt positioned at the time and place where individuals choose their method of ascent, stair climbing increased significantly. Visibility of a prompt at the time behavioural choice is made appears necessary to change actual behaviour.

Does perceived steepness deter stair climbing when an alternative is available

Perception of hill slant is exaggerated in explicit awareness. Proffitt (Perspectives on Psychological Science 1:110–122, 2006) argued that explicit perception of the slant of a climb allows individuals to plan locomotion in keeping with their available locomotor resources, yet no behavioral evidence supports this contention. Pedestrians in a built environment can often avoid climbing stairs, the man-made equivalent of steep hills, by choosing an adjacent escalator. Stair climbing is avoided more by women, the old, and the overweight than by their comparators. Two studies tested perceived steepness of the stairs as a cue that promotes this avoidance. In the first study, participants estimated the steepness of a staircase in a train station (n = 269). Sex, age, height, and weight were recorded. Women, older individuals, and those who were heavier and shorter reported the staircase as steeper than did their comparison groups. In a follow-up study in a shopping mall, pedestrians were recruited from those who chose the stairs and those who avoided them, with the samples stratified for sex, age, and weight status. Participants (n = 229) estimated the steepness of a life-sized image of the stairs they had just encountered, presented on the wall of a vacant shop in the mall. Pedestrians who avoided stair climbing by choosing the escalator reported the stairs as steeper even when demographic differences were controlled. Perceived steepness may to be a contextual cue that pedestrians use to avoid stair climbing when an alternative is available.

Brief interventions for weight loss in primary care

Overweight and obesity are common and important causes of chronic disease. This should mean that primary care physicians feel tackling obesity is important, but it is uncommon for them to do so. Physicians perceive that this is not their job; they fear offending their patients and are unclear what may be effective. In this review we found two systematic reviews showing that motivational interviewing can lead to effective weight loss but it may not be practicable in this setting. Two trials show referral to specially trained nurses in primary care appears ineffective. Several randomized trials show referral to commercial weight management companies is effective. Observational data but no trials suggest that screening for and opportunistic brief interventions may motivate attempts to lose weight and lead to some weight loss. We conclude there is insufficient evidence to promote treatment opportunistically but sufficient evidence to refer patients wanting to lose weight to commercial weight management services.

The feasibility and acceptability of regular weighing of pregnant women by community midwives to prevent excessive weight gain: RCT

Pregnancy is a critical period for the development of later obesity. Regular weighing of pregnant women is not currently recommended in the UK. This study aimed to demonstrate the feasibility of regular weighing by community midwives (CMWs) as a potential intervention to prevent excessive gestational weight gain. Low risk healthy/overweight pregnant women cared for by eight CMWs were randomised to usual care or usual care plus the intervention at 10-14 weeks of pregnancy. The intervention involved CMWs weighing and charting weight gain on an IOM weight gain chart, setting a weight target and giving brief feedback at antenatal appointments. The focus of the study was on process evaluation outcomes. Data on other outcomes were also collected including gestational weight gain. We interviewed women and CMWs about their views of the intervention. CMWs referred 123 women, 95 agreed to participate and 76 were randomised. Over 90% of women were weighed at 38 weeks of pregnancy demonstrating high follow up. There was no evidence the intervention caused anxiety. Most women commented they had found the intervention useful in encouraging them to think about their weight and believed it should be part of routine antenatal care. CMWs felt the intervention could be implemented within antenatal care without adding substantially to consultation length. To conclude, pregnant women were keen to participate in the study and the intervention was acceptable to pregnant women and CMWs. An effectiveness trial is now planned.

Slimming World in Stop Smoking Services (SWISSS): study protocol for a randomized controlled trial

BackgroundQuitting smokers gain weight. This deters some from trying to stop smoking and may explain the increased incidence of type 2 diabetes after cessation. Dieting when stopping smoking may be counterproductive. Hunger increases cravings for smoking and tackling two behaviours together may undermine quitting success. A meta-analysis of randomized controlled trials (RCTs) showed individualized dietary support may prevent weight gain, although there is insufficient evidence whether it undermines smoking cessation. Commercial weight management providers (CWMPs), such as Slimming World, provide individualized dietary support for National Health Service (NHS) patients; however, there is no evidence that they can prevent cessation-related weight gain.Our objective is to determine whether attending Slimming World from quit date, through referral from NHS Stop Smoking Services, is more effective than usual care at preventing cessation-related weight gain.MethodsThis RCT will examine the effectiveness of usual cessation support plus referral to Slimming World compared to usual cessation support alone. Healthy weight, overweight and obese adult smokers attending Stop Smoking Services will be included. The primary outcome is weight change in quitters 12 weeks post-randomization. Multivariable linear regression analysis will compare weight change between trial arms and adjust for known predictors of cessation-related weight gain.We will recruit 320 participants, with 160 participants in each arm. An alpha error rate of 5% and 90% power will detect a 2 kg (SD = 2.5) difference in weight gain at 12 weeks, assuming 20% remain abstinent by then.DiscussionThis trial will establish whether referral to the 12-week Slimming World programme plus usual care is an effective intervention to prevent cessation-related weight gain. If so, we will seek to establish whether weight control comes at the expense of a successful quit attempt in a further non-inferiority trial.Positive results from both these trials would provide a potential solution to cessation-related weight gain, which could be rolled out across England within Stop Smoking Services to better meet the needs of 0.75 million smokers stopping with NHS support every year.Trial registrationCurrent Controlled Trials ISRCTN65705512

Prompt before the choice is made: Effects of a stair-climbing intervention in university buildings: Prompt before the choice is made

OBJECTIVES   Recent interventions report positive results following a multi-component campaign to increase stair climbing. This study investigated the effectiveness of volitional and motivational components of a stair-climbing intervention in the workplace. Design.  Interrupted time-series design. METHODS   Ascending stair/lift choices, coded by gender, were observed between 08:00-10:00 and 14:15-16:15 on weekdays, in four university buildings (n = 14,138; 46% female). Baseline observations (stage 1; 5 days) preceded a motivational intervention, that is, a poster positioned inside the lift(s), that was positioned in each building (stage 2; 5 days). Next a volitional intervention, that is, point-of-choice prompt, supplemented the motivational one (stage 3; 8 days). Logistic regression analysis of stair/lift choices included the independent variables of intervention components, gender, time of day, building height, number of lifts, and pedestrian traffic. RESULTS   There was no significant change in stair climbing when the motivational component was positioned alone (Odds Ratio [OR] = 0.93, 95% Confidence Interval [CI] = 0.85-1.02, p = .123). In contrast, stair climbing increased significantly when the volitional component, that is, the point-of-choice prompt, was added (OR = 1.23, 95% CI = 1.14-1.32, p < .001). During both stages, building height, number of lifts, time of day, and pedestrian traffic were all associated with stair climbing. No significant gender effects were seen. CONCLUSIONS   A motivational component positioned alone, inside the lift(s) did not increase stair climbing. When a volitional component was added, that is, point-of-choice prompt positioned at the time and place where individuals choose their method of ascent, stair climbing increased significantly. Visibility of a prompt at the time behavioural choice is made appears necessary to change actual behaviour.