Gretchen Benson

Self-weighing promotes weight loss for obese adults.

BACKGROUND Frequent self-weighing has been proposed as an adjuvant strategy to promote weight loss. Not all experts agree on its utility, and the literature supporting its effectiveness is somewhat limited by methodologic shortcomings related to the subjective assessment of self-weighing frequency. DESIGN A prospective cohort design was utilized to examine 100 participants enrolled in a weight-loss trial that encouraged frequent, objectively measured self-weighing at home. Measurements were made at pretreatment and at follow-up visits at 6 and 12 months. SETTING/PARTICIPANTS Participants were employed, obese adults enrolled in the Weigh By Day trial. Study data were collected between October 2005 and May 2007. INTERVENTION The intervention consisted of a 6-month behavioral weight-loss program that employed telephone counseling, a written manual, and a home telemonitoring scale. MAIN OUTCOME MEASURES The primary outcomes of interest were body weight and clinically meaningful weight loss (i.e., > or =5%). Analyses were performed in March 2008. RESULTS Self-weighing was a significant predictor of body weight over time. Participants lost about 1 extra pound for every 11 days they self-weighed during treatment. In addition, participants who self-weighed at least weekly were 11 times more likely to lose at least 5% of their pretreatment weight after 6 months. Improvements attenuated after 12 months. CONCLUSIONS Self-weighing may be a strategy to enhance behavioral weight-loss programs. Weekly self-weighing seems to be a reasonable, evidence-supported recommendation for successful weight loss, but more research is warranted to determine the independent contribution of self-weighing to successful weight loss, as well as its potential risk of negative psychological impact.

Telephone counseling and home telemonitoring: the weigh by day trial.

OBJECTIVE To test the effects of telephone counseling and telemonitoring on weight loss. METHODS A randomized-controlled trial was conducted over 18 months. Participants were assigned to an immediate or delayed-start group. The intervention included a Thin-Link((R)) home telemonitoring scale and biweekly telephone counseling over 6 months. RESULTS The immediate group lost significantly more weight relative to the delayed group over the first 6 months (-7.5 versus +1.3 pounds) and at subsequent visits. CONCLUSION Compared to no treatment, the intervention was effective at producing weight loss. Home telemonitoring may enhance standard weight-loss counseling.

HeartBeat Connections: A Rural Community of Solution for Cardiovascular Health

Background: Cardiovascular disease (CVD) continues to be the leading cause of death among Americans. National guidelines emphasize early identification and control of CVD risk factors, but challenges remain in the primary care setting in terms of engaging patients and improving medical therapy adherence. The rapid growth of electronic health records (EHRs) provides a new way to proactively identify populations of high-risk patients and target them with prevention strategies. The HeartBeat Connections (HBC) program was developed as part of a population-based demonstration project aimed at reducing myocardial infarctions. Methods: HBC uses EHR data to identify residents at high CVD risk in a rural community. Participants receive coaching from a registered dietitian or a registered nurse focused on lifestyle behavior changes and preventive medication initiation/titration. Discussion: HBC provides patients with access to nonprescribing professionals on a more frequent basis than typical office visits, and it is focused specifically on helping patients improve lifestyle behaviors and medication adherence as they relate to the primary prevention of CVD. Conclusion: Innovative population health approaches that use EHR data to address common barriers to CVD prevention and engage communities in addressing population health needs are needed to help more patients prevent coronary events.

Changes in cardiovascular risk factors after 5 years of implementation of a population-based program to reduce cardiovascular disease: The Heart of New Ulm Project

BACKGROUND Population-based interventions aimed at reducing cardiovascular disease (CVD) hold significant potential and will be increasingly relied upon as the model for health care changes in the United States. METHODS The Heart of New Ulm Project is a population-based project with health care, community, and workplace interventions addressing multiple levels of the social-ecological model designed to reduce modifiable CVD risk factors in rural New Ulm, MN. The community is served by one health system, enabling the use of electronic health record data for surveillance. Electronic health record data were extracted at baseline (2008-2009) and 2 follow-up periods (2010-2011, 2012-2013) for residents aged 40 to 79 years. Generalized estimating equations were used to fit longitudinal models of the risk factors. RESULTS Of 7,855 residents in the target population, 80% had electronic health record data for each period. The prevalence of at goal (blood pressure [BP] <140/90 mm Hg) and (low-density lipoprotein cholesterol [LDL-C] <130 mg/dL) increased from 79.3% to 86.4% and 68.9% to 71.1%, respectively, from baseline to 5 years, with the largest reductions in BP and LDL-C seen in individuals not at goal at baseline. Blood pressure and lipid-lowering medication use increased from 41.8% to 44.0% and 25.3% to 29.1%, respectively. The proportion at goal for glucose increased from 46.9% to 48.2%. The prevalence body mass index <30 kg/m(2) (55%) did not change, whereas the proportion at-goal for high-density lipoprotein decreased from 63.8% to 58%, and smoking showed an increase from 11.3% to 13.6%. CONCLUSION In a community participating in a multifaceted, population-based project aimed at reducing modifiable CVD risk factors, significant improvements in BP, LDL-C, and glucose were observed for 5 years, and body mass index remained stable in a state where obesity was increasing.

Rationale for the Use of a Mediterranean Diet in Diabetes Management

Recent estimates point to the stark reality that one in three people will have diabetes by 2050.1 As the epidemic of diabetes continues to grow, educators aim to help those with diagnosed diabetes live healthier lives. To date, much evidence-based information exists on how to help our patients reduce their health risks and potentially add quality years to their lives. Both lay and professional publications often emphasize managing the ABCs—A1C, blood pressure, and cholesterol—for optimal diabetes management. The American Diabetes Association (ADA) recommends lowering A1C to < 7%, controlling blood pressure to < 130/80 mmHg, and controlling LDL cholesterol to < 100 mg/dl (< 70 mg/dl for those with diagnosed cardiovascular disease [CVD]) to reduce the risk of microvascular and cardiovascular complications.2 Although these recommendations have not shifted greatly over the years, diabetes management in the population continues to be less than optimal. Data from the National Health and Nutrition Examination Survey of 2001–2002 indicated that an estimated 53% of individuals with diabetes failed to attain target blood pressure levels, and 50.2% were not at goal for A1C.3 Given these statistics, it is not surprising that death from coronary heart disease (CHD) and the risk of having a stroke is two to four times greater in adults with diabetes than in those without diabetes.4 Nutrition therapy and regular physical activity are the cornerstones for managing A1C, blood pressure, and cholesterol, and treatment for each has its own set of nutrition guidelines. Although there is some overlap in the recommendations, nutrition guidelines can be complex and confusing to people with diabetes who are often working to manage their diabetes in combination with other health risks. For example, nutrition recommendations often require an individual have advanced skills, such as label reading or data interpretation (e.g., calculation of carbohydrate …

Reach and effectiveness of the HeartBeat Connections telemedicine pilot program

Introduction Innovative care delivery programs that support primary care providers are needed to reduce the burden of cardiovascular disease (CVD). HeartBeat Connections (HBC) is a primary prevention telemedicine program utilizing registered dietitian nutritionists (RDNs) and registered nurses (RNs) to deliver health coaching and medication therapy protocols for dyslipidaemia and hypertension among patients at high risk for developing CVD. Methods This retrospective cohort study documents the reach and six-month effectiveness of the HBC program for improving CVD risk factors. The sample included 1028 high-risk individuals aged 40–79 (without CVD or diabetes) served between 2010 and 2013 (326 participants, 702 eligible non-participants). Mixed-model analyses of variance were used to compare changes in outcome measures between baseline and six-month follow-up for participants and non-participants. Outcomes were also examined for three groups: non-participants, participants with 1–4 encounters, and participants with > 5 encounters. Results Nearly one-third of all eligible patients participated. There were no significant differences over time between HBC participants and non-participants in blood pressure or body mass. A higher proportion of HBC participants quit using tobacco (7.0 vs. 3.2%, p = 0.004) and achieved the low-density lipoprotein (LDL) program goal of < 100 mg/dL (8.9 vs. –1.1%, p = 0.009). Also, more favourable improvements in total and LDL cholesterol were observed among HBC participants with higher program engagement (p < 0.05). Discussion The HBC telemedicine program resulted in significant improvement in some, but not all, CVD risk factors over six months. HBC reached many high-CVD-risk patients in the target region, which may confer population-level health benefits if this program can be scaled and sustained. Innovative, collaborative care delivery models like HBC can serve as a platform to systematically target and proactively engage at-risk populations, perhaps reducing patients’ CVD risk.

Weight Loss Surgery: Common Questions

It is often reported that weight loss surgery is the most effective weight loss method for extreme obesity.1 The number of procedures has increased dramatically during the past decade. From 1999-2001 to 2002-2004, the number increased more than ninefold, topping 100,000 procedures performed annually.2 Several studies have outlined the benefits of weight loss surgery on obesity-related comorbidities, including hypertension, hyperlipidemia, and diabetes.3 As the health-related benefits of weight loss surgery, particularly related to type 2 diabetes, continue to become elucidated, diabetes educators will be increasingly called on to provide pre- and postsurgery support to patients. This article outlines some common questions asked during patient visits and presents evidence-informed responses. Question: Are exercise and weight loss before bariatric surgery beneficial? Answer: The question of whether to encourage—or even require—weight loss before bariatric surgery remains debatable. However, recent studies point to the increasing benefits of modest weight loss in obese adults before surgery. Weight loss benefits related to the surgery itself include reduced liver size and reduced operating time. Extreme obesity often accompanies an enlarged, fatty liver. The increased size of the liver poses technical difficulties in terms of the surgeons ability to view and maneuver during surgery, especially during laparoscopic procedures.4 Fris5 looked at the connection between preoperative weight loss and liver size and found that weight loss strongly correlated to reduction in liver size. Additionally, some studies have found that preoperative weight loss may lead to reduction in operating time.6,7 One study found that preoperative weight loss > 5% shortened operating time by 36 minutes.7 Patients who lose weight before surgery may be more successful at weight loss after surgery.6 Alvarado …

Assessing the impact of the heart of New Ulm Project on cardiovascular disease risk factors: A population-based program to reduce cardiovascular disease

The Heart of New Ulm Project (HONU), is a population-based project designed to reduce modifiable cardiovascular disease (CVD) risk factors in the rural community of New Ulm, MN. HONU interventions address multiple levels of the social-ecological model. The community is served by one health system, enabling the use of electronic health record (EHR) data for surveillance. The purpose of this study was to assess if trends in CVD risk factors and healthcare utilization differed between a cohort of New Ulm residents age 40-79 and matched controls selected from a similar community, using EHR data from baseline (2008-2009) through three follow up time periods (2010-2011, 2012-2013, 2014-2015). Matching, using covariate balance sparse technique, yielded a sample of 4077 New Ulm residents and 4077 controls. We used mixed effects longitudinal models to examine trends over time between the two groups. Blood pressure, total cholesterol, low-density lipoprotein-cholesterol, and triglycerides showed better management in New Ulm over time compared to the controls. The proportion of residents in New Ulm with controlled blood pressure increased by 6.2 percentage points compared to an increase of 2 points in controls (p < 0.0001). As the cohort aged, 10-year ASCVD risk scores increased less in New Ulm (5.1) than the comparison community (5.9). The intervention and control community did not differ with regard to inpatient stays, smoking, or glucose. Findings suggest efficacy for the HONU project interventions for some outcomes.

What the Latest Evidence Tells Us About Fat and Cardiovascular Health

Diabetes has long been considered a risk equivalent to coronary heart disease (CHD) (1,2). The first report of the National Cholesterol Education Program, released in 1988, encouraged therapeutic lifestyle changes (nutrition, weight management, and physical activity) as first-line therapy for treating high blood cholesterol. Included in these recommendations was advice to eat a low-fat, low-cholesterol diet (3). This article presents a summary of the current evidence regarding dietary fat as it relates to diabetes and heart health, including the shift to thinking about type (or quality) of fat, rather than focusing as much on quantity. In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines for the treatment of blood cholesterol. These guidelines recommended a significant shift from aiming for specific LDL cholesterol goals to considering the overall risk level for having both a heart attack and stroke (4). The guidelines also identified four major groups of patients for whom statin medications are indicated because they have the greatest likelihood of preventing stroke and heart attacks, including individuals with diabetes who are 40–75 years of age. Although treating based on risk now trumps treating to LDL targets, the ACC/AHA re-emphasized that lifestyle modification remains a crucial component of cardiovascular disease (CVD) risk reduction, both before and with the use of cholesterol-lowering medications (5). As of 2015, the American Diabetes Association (ADA) Standards of Medical Care in Diabetes have aligned with the ACC/AHA guidelines and recommend statin therapy for all adults with diabetes who have CVD risk factors or overt CVD, unless contraindicated or not tolerated (6). Current diabetes nutrition recommendations center around individualized eating patterns that focus on a nutrient-rich, whole-foods approach (in appropriate portions) to attain individual blood glucose, blood pressure, blood lipid, and body weight goals, as well …

PRIMARY CARDIOVASCULAR DISEASE PREVENTION IS LEAVING THE OFFICE: EARLY RESULTS FROM THE HEARTBEAT CONNECTIONS INTEGRATED TELEMEDICINE PROGRAM

HeartBeat Connections (HBC) is a telemedicine program that integrates with and complements primary care. Nurse- and dietitian-led telephonic coaching focuses on controlling key cardiovascular disease (CVD) risk factors, and includes initiation/titration of dyslipidemia and hypertension medications