Chelsey Solar

A novel stepped-care approach to weight loss: The role of self-monitoring and health literacy in treatment outcomes

OBJECTIVES The aims of the current study were twofold: 1) examine the effectiveness of an innovative three-step, stepped-care behavioral weight loss treatment, and 2) examine factors that contribute to poor weight loss outcomes and the need for more intensive treatment. METHODS The total sample for the study consisted of 53 individuals (87% female) with MBMI=35.6, SDBMI=6.4. A three-step, stepped-care treatment approach was implemented over six months. Step 1 included the Diabetes Prevention Program manual adapted for self-administration augmented with monitoring technology shown to facilitate weight loss and participant accountability and engagement. Participants who were unsuccessful at achieving established weight loss goals received stepped-up treatments in 2-month increments beginning at month 2. The stepped progression included the addition of meal replacement at Step 2 and individual counseling concurrent with meal replacement at Step 3. RESULTS Un-stepped and once stepped participants lost a clinically significant amount of weight (i.e., >5%), while twice stepped participants lost an insignificant amount of weight. Twice stepped participants were significantly lower in health literacy and self-monitoring frequency. CONCLUSIONS In this investigation, approximately 60% of the participants were able to lose a clinically significant amount of weight utilizing a minimally intensive intervention with little additional support. Regular self-monitoring and high health literacy proved to be significant correlates of success.

The intervention composed of aerobic training and non-exercise physical activity (I-CAN) study: Rationale, design and methods

Recent data has suggested that prolonged sedentary behavior is independent risk factor for cardiovascular and all-cause mortality independent of adequate amounts of moderate to vigorous physical activity. However, few studies have prospectively evaluated if exercise training and increasing non-exercise physical activity leads to greater reduction in cardiometabolic risk compared to aerobic training alone. The purpose of the Intervention Composed of Aerobic Training and Non-Exercise Physical Activity (I-CAN) study is to determine whether a physical activity program composed of both aerobic training (consistent with public health recommendations) and increasing non-exercise physical activity (3000 steps above baseline levels) leads to enhanced improvements in waist circumference, oral glucose tolerance, systemic inflammation, body composition, and fitness compared to aerobic training alone in obese adults (N=45). Commercially available accelerometers (Fitbits) will be used to monitor physical activity levels and behavioral coaching will be used to develop strategies of how to increase non-exercise physical activity levels. In this manuscript, we describe the design, rationale, and methodology associated with the I-CAN study.

COMRADE: A randomized trial of an individually tailored integrated care intervention for uncontrolled type 2 diabetes with depression and/or distress in the rural southeastern US

BACKGROUND Emerging evidence suggests that people living with Type 2 diabetes mellitus (T2D) are also at greater risk for depression and distress. If left untreated, these comorbid mental health concerns can have long-lasting impacts on medical and physical health outcomes. DESIGN This prospective trial randomized rural men and women with uncontrolled T2D (HbA1c ≥ 7.0) who screened positive for co-morbid depressive (PHQ-2 > 3) or distress (DDS-2 > 3) symptoms in a primary medical care setting to receive either: 1) 16 sessions of cognitive and/or behavioral intervention tailored to symptom severity across 12 months along with routine medical care, or 2) usual primary care. Outcomes included change from baseline to 12-months in HbA1c, diabetes related distress, depressive symptoms, and diabetes self-care activities. BASELINE RESULTS 139 patients (Mean age = 52.6 ± 9.6 years) with T2D from impoverished rural communities were enrolled (almost half reporting annual income of <

Changes in Perceived Mate Value and Weight Bias Associated With Former Obesity Status.

10,000 per year). Baseline data indicated that patients were experiencing profoundly uncontrolled T2D of a long duration (Mean HbA1c = 9.61 ± 2.0; Mean BMI = 37.0 ± 9.1; Mean duration = 11.2 ± 8.9 years) along with high levels of distress (Mean DDS-17 Scale Score = 2.5 ± 1.0) and/or depressive symptoms (Mean PHQ-9 Scale Score = 9.3 ± 6.1). CONCLUSION Patients with uncontrolled T2D of long duration manifest complex co-morbidities including associated obesity, depressive symptoms and/or diabetes related distress. A behavioral intervention for T2D that concurrently targets symptoms of depression and distress may lead to more effective outcomes in this high-risk population. CLINICAL TRIAL REGISTRATION NCT02863523.

An ecological momentary assessment of weight stigma among weight loss participants

Weight bias and discrimination against individuals with obesity are prevalent and persistent, even after weight loss. The purpose of the present study was to determine if ratings of mate value and romantic interest change after learning that an opposite sex target was formerly obese and whether method of weight loss (diet and exercise, bariatric surgery, or diet pills) influenced ratings. Participants were 296 men and 350 women enrolled at a large southeastern university. The participants in the experimental conditions were provided with a vignette of 2 images of a member of the opposite sex: 1 with obesity and the other with a thin physique. Participants were informed of the model’s weight loss method. Two control conditions presented either the thin target or the obese target with no weight loss portion to the vignette. The participants evaluated the mate value, personality traits, and interest in having the target as a friend, girl/boyfriend, or spouse. The thin target with no weight loss history was rated more favorably than the overweight target with no weight loss history. However, when male participants learned that the thin female target was previously heavy, they then rated her less favorably regardless of weight loss method. In contrast, women viewed the previously obese male target who lost weight via diet and exercise more favorably and viewed men that lost weight with diet pills less favorably than men that lost weight via bariatric surgery. The negative views of individuals who were formerly obese appear to extend to mate selection.

Impact of Distress Reduction on Behavioral Correlates and A1C in African American Women with Uncontrolled Type 2 Diabetes: Results from EMPOWER

This investigation explored experiences of weight stigma using momentary, real-time diary assessments among adults seeking weight loss treatment. In total, 51 participants completed diary assessments of weight stigmatizing events and reported how they felt and coped with each incident. Experiencing stigma was significantly associated with fewer positive and greater negative emotions. There was a significant inverse relationship between using positive self-talk and feeling numb and a positive relationship between using isolation/avoidance coping and feeling depressed, ashamed, and less happy. The significant negative momentary impacts of weight stigma likely contribute to the long-term negative consequences of experiencing weight stigma.

Psychometric Properties of the Family Support Scale Adapted for African American Women with Type 2 Diabetes Mellitus

OBJECTIVE Symptoms of emotional distress related to diabetes have been associated with inadequate self-care behaviors, medication non-adherence, and poor glycemic control that may predispose patients to premature death. African American women, in whom diabetes is more common and social support is often insufficient, may be at particularly high risk. The objective of this study was to examine the impact of lowering diabetes-related emotional distress on glycemic control and associated behavioral correlates in rural African American women with uncontrolled type 2 diabetes (T2D). DESIGN Post-hoc analysis of prospective, randomized, controlled trial. SETTING Rural communities in the southeastern United States. PATIENTS 129 rural middle-aged African American women with uncontrolled type 2 diabetes (T2D)(A1C ≥ 7.0). PRIMARY INDEPENDENT VARIABLE Diabetes-related distress. MAIN OUTCOME MEASURES Changes from baseline to 12-month follow-up in diabetes-related distress, and associated changes in medication adherence, self-care activities, self-efficacy, and glycemic control (A1C). RESULTS Patients with a reduction in diabetes-related distress (n=79) had significantly greater improvement in A1C, medication adherence, self-care activities, and self-efficacy compared with those in whom diabetes distress worsened or was unchanged (n=50). Changes in distress were also significantly and inversely correlated with improvements in medication adherence, self-care activities, and self-efficacy. CONCLUSIONS Among rural African American women, reductions in diabetes-related distress may be associated with lower A1C and improvements in self-efficacy, self-care behaviors, and medication adherence.