Jean Harvey

eHealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta-analysis

A systematic review of randomized controlled trials was conducted to evaluate the effectiveness of eHealth interventions for the prevention and treatment of overweight and obesity in adults. Eight databases were searched for studies published in English from 1995 to 17 September 2014. Eighty‐four studies were included, with 183 intervention arms, of which 76% (n = 139) included an eHealth component. Sixty‐one studies had the primary aim of weight loss, 10 weight loss maintenance, eight weight gain prevention, and five weight loss and maintenance. eHealth interventions were predominantly delivered using the Internet, but also email, text messages, monitoring devices, mobile applications, computer programs, podcasts and personal digital assistants. Forty percent (n = 55) of interventions used more than one type of technology, and 43.2% (n = 60) were delivered solely using eHealth technologies. Meta‐analyses demonstrated significantly greater weight loss (kg) in eHealth weight loss interventions compared with control (MD −2.70 [−3.33,−2.08], P < 0.001) or minimal interventions (MD −1.40 [−1.98,−0.82], P < 0.001), and in eHealth weight loss interventions with extra components or technologies (MD 1.46 [0.80, 2.13], P < 0.001) compared with standard eHealth programmes. The findings support the use of eHealth interventions as a treatment option for obesity, but there is insufficient evidence for the effectiveness of eHealth interventions for weight loss maintenance or weight gain prevention.

Effects on food cravings of a very low calorie diet or a balanced, low calorie diet.

It is commonly believed that dieting and the restriction of specific types of foods produces cravings for these foods. This study, therefore, compared changes in self-reported cravings experienced by 93 obese subjects with Type II diabetes who were randomly assigned to behavioral treatment programmes which used either: (a) a balanced, low-calorie diet (LCD) of 1000-1200 kcal/day throughout, with all foods allowed in moderation, or (b) a programme which included a 12-week period of a very low calorie diet (VLCD), where intake was restricted to 400 kcal/day with only lean meat, fish, or fowl allowed. There were significant decreases in cravings for all types of foods over the 20 weeks of the study for both the VLCD and the LCD conditions. The decreases in cravings were particularly pronounced for the VLCD condition for low-fat, high-protein foods (the only foods allowed on the VLCD) and for complex carbohydrates, especially grains (one of the types of foods prohibited on this diet). There was no evidence to support the belief that restricting intake of certain foods leads to increased craving for these foods or that the magnitude of weight loss is related to food cravings.

Obesity Treatment in Disadvantaged Population Groups: Where Do We Stand and What Can We Do?

Obesity is now the second leading cause of death and disease in the United States leading to health care expenditures exceeding

Video Consultations and Virtual Nutrition Care for Weight Management

147 billion dollars. The socioeconomically disadvantaged and racial/ethnic minority groups are at significantly increased risk for obesity. Despite this, low income and minority individuals are underrepresented in the current obesity treatment literature. Additionally, weight loss outcomes for these high risk groups are well below what is typically produced in standard, well-controlled behavioral interventions and reach and access to treatment is often limited. The use of telecommunications technology may provide a solution to this dilemma by expanding dissemination and allowing for dynamic tailoring. Further gains may be achieved with the use of material incentives to enhance uptake of new behaviors. Regardless of what novel strategies are deployed, the need for further research to improve the health disparities associated with obesity in disadvantaged groups is critical. The purpose of this manuscript is to review the weight loss intervention literature that has targeted socioeconomically disadvantaged and racial/ethnic minority populations with an eye toward understanding outcomes, current limitations, areas for improvement and need for further research.

A comprehensive approach to understanding cooking behavior: Implications for research and practice

This article was written by Megan E. Rollo, PhD, APD*, postdoctoral researcher, School of Health Sciences, Melinda J. Hutchesson, PhD, APD*, National Heart Foundation postdoctoral research fellow and lecturer in nutrition and dietetics, School of Health Sciences, Tracy L. Burrows, PhD, AdvAPD, senior lecturer in nutrition and dietetics, School of Health Sciences, all at Priority Research Center in Physical Activity and Nutrition, University of Newcastle, New South Wales, Australia; Rebecca A. Krukowski, PhD, assistant professor, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis; Jean R. Harvey, PhD, RD, chair, Department of Nutrition and Food Sciences, and professor, Department of Nutrition and Food Sciences and Department of Medicine, University of Vermont, Burlington; Lindsey B. Hoggle, MS, RDN, director, Nutrition Informatics, Academy of Nutrition and Dietetics, Washington, DC; and Clare E. Collins, PhD, FDAA, professor in nutrition and dietetics and strategic research fellow, School of Health Sciences, Faculty of Health and Medicine, and codirector, Priority Research Centre in Physical Activity and Nutrition, School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia. APD is the Australian certification for an accredited practicing dietitian. AdvAPD is the Australian advanced accredited practicing dietitian credential. FDAA indicates fellowship in the Dietitians Association of Australia.

The Impact of Incentives on Intrinsic and Extrinsic Motives for Fitness-Center Attendance in College First-Year Students

Purpose The purpose of this paper is to describe the development of – and need for – an expanded understanding of cooking (skills and knowledge) to inform research on the connection between cooking and health. Design/methodology/approach This paper describes a concept of “food agency” and contrasts it with how cooking is commonly conceived in food and nutrition literature. A food agency-based pedagogy and proposals for using it are also introduced. Findings Cooking is a complex process that may be crucial for making a difference in the contemporary problems of diet-related chronic diseases. There are two interlinked problems with present research on cooking. First, cooking has yet to be adequately conceptualized for the design and evaluation of effective public health and nutrition interventions. The context within which food-related decisions and actions occur has been neglected. Instead, the major focus has been on discrete mechanical tasks. In particular, recipes are relied upon despite no clear evidence that recipes move people from knowledge to action. Second, given the incomplete theorization and definition of this vital everyday practice, intervention designs tend to rely on assumptions over theory. This creates certain forms of tautological reasoning when claims are made about how behavior changes. A comprehensive theory of food agency provides a nuanced understanding of daily food practices and clarifies how to teach cooking skills that are generalizable throughout varied life contexts. Originality/value This commentary is of value to academics studying cooking-related behavior and public health practitioners implementing and evaluating cooking interventions.

Design and Methods of a Synchronous Online Motivational Interviewing Intervention for Weight Management

Purpose. A criticism of incentives for health behaviors is that incentives undermine intrinsic motivation. The objective of this study was to determine the impact of monetary incentive provision on participation motives for exercise in first-year college students at a northeastern public university. Design. Randomized-controlled trial. Setting. Public university in the Northeastern United States. Subjects. One hundred seventeen first-year college students. Intervention. Participants were randomized to one of three conditions: a control condition receiving no incentives for meeting fitness-center attendance goals; a discontinued-incentive condition receiving weekly incentives during fall semester 2011, and no incentives during spring semester 2012; or a continued-incentive condition receiving weekly incentives during fall semester, and incentives on a variable-interval schedule during spring semester. Measures. The Exercise Motivation Inventory 2 measured exercise participation motives at baseline, end of fall semester, and end of spring semester. Fitness-center attendance was monitored by using ID-card check-in/check-out records. Analysis. Repeated-measures analyses using linear mixed models with first-order autoregressive covariance structures were run to compare motive changes in the three conditions. Results. Participation motives of Enjoyment and Revitalization associated with intrinsic motivation did not decrease significantly over time in any of the conditions, F(4, 218) = 2.25, p = .065 and F(4, 220) = 1.67, p = .16, respectively. Conclusion. Intrinsically associated participation motives for exercise did not decrease with incentive provision. Therefore, incentives may encourage fitness-center attendance without negatively impacting participation motives for exercise.

Remission of recently diagnosed type 2 diabetes mellitus with weight loss and exercise.

Background While Internet-based weight management programs can facilitate access to and engagement in evidence-based lifestyle weight loss programs, the results have generally not been as effective as in-person programs. Furthermore, motivational interviewing (MI) has shown promise as a technique for enhancing weight loss outcomes within face-to-face programs. Objective This paper describes the design, intervention development, and analysis of a therapist-delivered online MI intervention for weight loss in the context of an online weight loss program. Methods The MI intervention is delivered within the context of a randomized controlled trial examining the efficacy of an 18-month, group-based, online behavioral weight control program plus individually administered, synchronous online MI sessions relative to the group-based program alone. Six individual 30-minute MI sessions are conducted in private chat rooms over 18 months by doctoral-level psychologists. Sessions use a semistructured interview format for content and session flow and incorporate core MI components (eg, collaborative agenda setting, open-ended questions, reflective listening and summary statements, objective data, and a focus on evoking and amplifying change talk). Results The project was funded in 2010 and enrollment was completed in 2012. Data analysis is currently under way and the first results are expected in 2016. Conclusions This is the first trial to test the efficacy of a synchronous online, one-on-one MI intervention designed to augment an online group behavioral weight loss program. If the addition of MI sessions proves to be successful, this intervention could be disseminated to enhance other distance-based weight loss interventions. Trial Registration Clinicaltrials.gov NCT01232699; https://clinicaltrials.gov/ct2/show/NCT01232699

Cholesterol Screening in the Elderly: Changing Attitudes

PURPOSE: To determine the rate of remission of recently diagnosed (<1 year) type 2 diabetes mellitus (T2DM) in overweight/obese individuals, with a 6-month program of weight loss and exercise. METHODS: Subjects (N = 12) were overweight/obese (body mass index = 35.8 ± 4.3 kg/m2), sedentary, and unfit ( O2peak = 20.7 ± 4.7 mL·kg−1·min−1) and recently (<1 year) diagnosed with T2DM. They were willing to participate in a lifestyle program of behavioral weight loss counseling and supervised exercise located at a cardiac rehabilitation program prior to consideration of diabetes medications. Glycated hemoglobin (HbA1c) level before and after the study intervention was the primary study outcome, along with secondary metabolic, fitness, and body composition variables. RESULTS: Subjects had a baseline HbA1c of 6.5% to 8.0% (mean 6.8 ± 0.2). Subjects lost 9.7 ± 0.2 kg body weight (9%) and improved peak aerobic capacity by 18%. Two subjects withdrew for medical reasons unrelated to the lifestyle program. Eight of 10 completers (80%) went into partial T2DM remission, with the mean HbA1c decreasing from 6.8 ± 0.2% to 6.2 ± 0.3% (P < .001). CONCLUSIONS: For individuals with recently diagnosed T2DM willing to undertake a formal lifestyle program, 80% of study completers and 67% of our total population achieved at least a partial T2DM remission at 6 months. Further study of this intervention at the time of diagnosis of T2DM with randomized controls and longer-term followup is warranted.

Do individual, online motivational interviewing chat sessions enhance weight loss in a group-based, online weight control program?

The purpose of this study was to assess an elderly populations (60-80 years old) attitudes toward health prevention and life-style change with a particular emphasis on cholesterol screening and management. A free cholesterol screen was offered to participants in exchange for completion of a 21-item questionnaire (including medical history, risk factors, attitudes on preventive health, eating patterns and demographic information). This study provides evidence for increasing awareness of elevated cholesterol levels as a risk factor for coronary heart disease. It also demonstrates that there is an attitude of willingness to modify dietary cholesterol and fat intake within this mobile elderly population.