Anna-Maria Keränen

The effect of eating behavior on weight loss and maintenance during a lifestyle intervention.

OBJECTIVE To investigate the effects of intensive counseling on eating behavior and weight loss and maintenance and their associations. METHODS A randomized weight loss counseling intervention with follow-up of 18 months, conducted between 2002-2004 at Oulu University Hospital, Finland included obese adults (n=82, body mass index >27 kg/m(2)). Subjects were randomized into 1) intensive counseling and 2) short-term counseling. Forty-nine subjects who completed the study were included. Eating behavior was repeatedly assessed by the Three Factor Eating Questionnaire-18 and Binge Eating Scale. RESULTS Eating behavior improved in both groups. Effect of counseling was -5.0+/-5.7 kg compared with -2.4+/-2.5 kg in the control group (p<0.05 between the groups) during the first 6 months. At 18 months the weight loss results were -2.6+/-6 kg and -0.7+/-3.5 kg, respectively (NS). Success in weight loss maintenance is associated with improved eating behavior (p<0.05). By contrast, failure in weight loss is associated with high scores of uncontrolled eating and binge eating symptoms at the baseline (p<0.05). CONCLUSIONS Both intensive and short-term interventions improved eating behavior and weight loss but there was no difference between the two modes of intervention. The association between the improvement of eating behaviour and the success of weight loss suggests a causal relationship which however should be confirmed in a prospective study focusing specifically on this aspect.

Effect of weight loss intervention on the association between eating behaviour measured by TFEQ-18 and dietary intake in adults.

Associations between eating behaviour (cognitive restraint, emotional eating and uncontrolled eating) and dietary intake (energy, energy nutrients and fibre) were assessed in overweight or obese adults (body mass index >27 kg/m(2), n=49) before and after weight loss intervention in a randomized follow-up study lasting 18 months. Counselling was either intensive or short-term. Eating behaviour was assessed using the three-factor eating questionnaire-18 and dietary intake with 5-day food records at 0 and 18 months. The only difference in dietary intake between the groups was higher protein intake (% of energy, E%) in the short-term group at 18 months (18.7 ± 3.1 E% vs. 17.1 ± 1.7 E%). Cognitive restraint was associated with lower energy intake at 0 and 18 months (r=-0.34, r=-0.36, respectively) and higher intakes of carbohydrates (r=0.39), sucrose (r=0.33) and fibre (r=0.44) and a lower intake of fat (r=-0.43) at 18 months. Those with the highest cognitive restraint at 18 months had the lowest energy and fat intake, the highest carbohydrate and fibre intake and the greatest weight loss. The results suggest that enhancing cognitive restraint could be a target for improving weight loss counselling, although further evaluation of the causal relationship would be needed in order to find the best practices for enhancing cognitive restraint.

Lifestyle intervention has a beneficial effect on eating behavior and long-term weight loss in obese adults

OBJECTIVE To investigate the change in eating behavior and the factors related with the change among successful dieters (maintained a weight loss of ≥5% of original weight). METHODS Obese adult subjects (21 male, 55 female) were randomized into three-year lifestyle intervention (n=59) and control groups (n=17). Eating behavior (cognitive restraint of eating, uncontrolled eating and emotional eating) was evaluated by the TFEQ-18 and motivation to lose weight and tolerance to problems by a separate questionnaire. Weight, height and body mass index were measured. RESULTS Weight decreased more in the intervention group than in the control group (5.0% vs 0.6%, p=0.027). Cognitive restraint increased twice as much in the intervention group compared to the control group (16.0 vs. 7.0, p=0.044). The increment in cognitive restraint was positively associated with weight loss and high baseline motivation and tolerance to problems. Cognitive restraint increased in both successful (n=27) and unsuccessful dieters (n=32), but only the successful dieters were able to decrease uncontrolled eating in the long term. CONCLUSIONS Our results showed that intensive lifestyle counseling improved cognitive restraint which was associated with enhanced weight loss among obese adults. Successful dieters also showed a long-term improvement of uncontrolled eating. Eating behavior should be evaluated and followed before and during lifestyle interventions in order to support the change, e.g. by finding methods to control eating at risk situations and strengthening motivation and tolerance to problems.

Feasibility of videoconferencing in lifestyle group counselling

Objectives. The rapid increase in the prevalence of type 2 diabetes (T2D) has created an urgent need to develop new practices to prevent and treat it. One possibility is to provide specialists services to remote areas through videoconferencing (VC). Therefore, the aim was to study the feasibility of short-term group counselling by a clinical nutritionist (4 sessions at 1.5-hour each at 2-week intervals from baseline, and the session 5 at 6 months) performed by videoconferencing (VC). Study design. We recruited 74 subjects at high risk of T2D, and compiled 5 VC groups (each group included 5–9 subjects, total n=33) and 6 face-to-face groups (FF, total n=44). The subjects were also asked to participate in a follow-up visit 15 months after the last counselling session. Methods. Data were collected by a questionnaire (satisfaction with group counselling via videoconferencing), by theme interviews (experiences on group counselling) and by metabolic measures (laboratory tests). Results. Only one of the 74 subjects dropped out during the first 6 months. The proportion of subjects who had received social support from group peers was higher in the videoconferencing group than in the face-to-face groups (p=0.001). The experiences of group counselling transmitted by videoconferencing were positive. Waist circumference decreased significantly at 0 to 6 months of counselling (p&0.01), and was significantly lower at 21 months than at baseline in FF groups (p=0.015). However, no significant differences were observed in most of the measurements between VC and face-to-face groups. Conclusions. Short-term group counselling by a clinical nutritionist through videoconferencing is a feasible way and a practical model to provide specialists services to remote areas, and thus can be used as an option to diminish inequality related to restricted health care services in sparsely inhabited areas.

Quitting a weight loss program is associated with anhedonia: preliminary findings of the Lifestyle Intervention Treatment Evaluation Study in northern Finland.

Objectives. To examine whether a diagnosis for major depression, chronic depression or specific symptoms of depression is associated with the risk of quitting a weight loss program. Study design. The study involved 82 overweight adults participating in the Lifestyle Intervention Treatment Evaluation (LITE) follow-up study at Oulu University Hospital in northern Finland. Methods. Psychiatric diagnostic assessments were based on the Structured Clinical Interview for DSMIV disorders (SCID-I) conducted by a clinical psychiatrist. Anhedonia (lack of pleasure) was assessed as one of the core symptoms of major depression and chronic depression (dysthymia). Anhedonia was defined to be present if the participants reported having suffered a major loss of interest during the previous month. Results. Twenty participants (24.4%) quit during the 6-month intervention period. Anhedonia put individuals at risk of quitting the weight loss program (bivariate analysis OR 3.1, 95% CI 0.8–11.6, p=0.091, multivariate analysis OR 6.5, 95% CI 1.1-38.2, p=0.038). However, a diagnosis for major depression or chronic depression did not predict quitting. Conclusions. Individual assessments of obesity and overweight should also include an assessment for subthreshold depression, mainly anhedonia.

Eating behavior in obese and overweight persons with and without anhedonia.

The aim of this study was to evaluate differences in body mass index and eating behavior in obese and overweight persons with and without anhedonia during a weight loss intervention study. Psychiatric diagnostics were based on the Structured Clinical Interview for DSM-IV disorders. Eating behavior was assessed by the Three Factor Eating Questionnaire (TFEQ-18) and binge eating by the Binge Eating Scale (BES). Out of 82 participants, 20 (24.4%) reported experiencing anhedonia at least once during the study period. Those suffering from anhedonia scored significantly higher values in BES at baseline and at follow-up. They also reported more uncontrolled and emotional eating at the first follow-up. Overall, persons suffering from anhedonia achieved a poorer outcome in weight loss compared to those without anhedonia. Anhedonia was associated with uncontrolled eating, emotional eating, and binge eating, all of which may have contributed to the poorer outcomes achieved in weight loss.

Everyday health information literacy among young men compared with adults with high risk for metabolic syndrome - a cross-sectional population-based study

This cross-sectional population-based study aims at identifying differences in the aspects of everyday health information literacy among young healthy men and adults with an increased risk for metabolic syndrome. Data were collected with a self-assessment-based 10-item screening tool administered at the Finnish Defence Force’s call-ups (n=2507, response rate 59%) and at health intervention study (n=571, response rate 98%). Adults with increased risk for metabolic syndrome seemed to value health information but had more difficulty in knowing who to believe in health issues and understanding the terminology used. The difficulties applied especially to respondents 35 years old or over. Men, and especially young men, had lower motivation than women to seek health information. Although the results are indicative, the everyday health information literacy screening tool seems to be useful in revealing areas that health communication should be focused on among different populations.

Flow or No Flow? A Qualitative Study of Health Behavior Change Support System

Recent studies about technology acceptance have highlighted the significance of hedonic values when examining consumer information systems. The flow experience is often taken as a theoretical construct to explain hedonic motivations in Web-related studies. However, regarding consumer healthcare information systems, the relevance of hedonic values has received relatively little attention. In this study Oinas-Kukkonens webflow model and its constructs are used to understand user experience in Behavior Change Support Systems (BCSSs) designed to prevent metabolic syndrome. Twelve participants were interviewed after using the system for ten weeks. Our findings suggest that in the area of consumer healthcare information systems, hedonic values are not as important as utilitarian values. This study demonstrates the value of the webflow model as a research framework and contributes to its further development. Methodologically, this paper contributes to a rarely used qualitative approach in studying the flow experience.

Effects of Group Counseling Transmitted Through Videoconferencing on Changes in Eating Behaviors.

OBJECTIVE To compare the effects of constructivism-based dietary group counseling transmitted through videoconferencing (VC) and face-to-face (FF) counseling on changes in eating behaviors. METHODS Altogether, 74 participants with high risk of type 2 diabetes were divided into FF and VC groups based on their place of residence in northern Finland. Constructivism-based dietary group counseling, a nonrandomized intervention, was performed (evaluations at 0, 6, and 21 months). The Three-Factor Eating Questionnaire-18 was used to evaluate cognitive restraint eating (CR), emotional eating (EE), and uncontrolled eating (UE). Data were analyzed using ANOVA and ANCOVA (significance level of 0.05). RESULTS Cognitive restraint eating increased and UE decreased between baseline and 6 months in both groups, but between baseline and 21 months only in the FF group (P = .005 and P = .021, respectively). Emotional eating decreased only in the VC group (P = .016). There were no differences between groups at 6 or 21 months. CONCLUSIONS AND IMPLICATIONS Constructivism-based counseling delivered through videoconferencing was effective at improving eating behaviors.

Everyday Health Information Literacy in Counselling on Healthy Eating. The Case of PrevMetSyn

The use of a screening tool for assessing everyday health information literacy (EHIL) is examined in counselling on healthy eating and lifestyle in the intervention study Improved Methods of Lifestyle Modification for Patients at High Risk for Metabolic Syndrome (PrevMetSyn) ongoing in Finland from 2013 to 2016. A case study with quantitative methods is used. The participants in a controlled intervention trial (based on a population-based sample of 560 subjects) were randomized into three groups: (1) intensive face-to-face counselling, (2) low-intensive face-to-face counselling, and (3) a control group, and further into users or non-users of a web-based ICT-programme. All participants’ EHIL was screened at the beginning. The analyses indicated the distributions of the EHIL scores. Accordingly, one visit was targeted on the perceived ability to assess the quality of health information in intensive face-to-face counselling. Applying the EHIL tool together with cognitive behavioral therapy is a novel counselling approach.