Kyeongra Yang

Randomized clinical trials of weight loss maintenance: a review.

The problem of overweight and obesity has reached epidemic proportions in the United States and globally, and the high prevalence is due in part to the recidivism associated with weight loss treatment. Approximately one-third of lost weight is often regained in the first year after treatment and, at times, continues. Because a plethora of comorbid diseases are associated with obesity, in particular, cardiovascular disease, hypertension, and hyperlipidemia, clinicians and researchers have attempted to find useful strategies for maintaining weight loss. This review presents the findings from 42 randomized clinical trials of weight loss maintenance from 1984 through 2007 using interventions that include (1) the Internet, (2) strategies after a very low calorie diet, (3) pharmacotherapy, (4) behavioral strategies, (5) physical activity, and (6) alternative strategies. The results of the reviewed trials revealed that treatment with orlistat or sibutramine combined with dietary modification, caffeine or protein supplementation, consuming a diet lower in fat, adherence to physical activity routines, prolonged contact with participants, problem-solving therapy, and the alternative treatment of acupressure were efficacious in reducing weight regain after weight loss treatment. The limitations of some studies may reduce the robustness of their findings, and future studies are necessary to replicate and support these results so that individuals are able to maintain weight loss and retain the health benefits associated with a lower weight.

A Review of Yoga Programs for Four Leading Risk Factors of Chronic Diseases

Yoga, a form of physical activity, is rapidly gaining in popularity and has many health benefits. Yet healthcare providers have been slow to recognize yoga for its ability to improve health conditions, and few interventions have been developed that take full advantage of its benefits. The purpose of this article is to review published studies using yoga programs and to determine the effect of yoga interventions on common risk factors of chronic diseases (overweight, hypertension, high glucose level and high cholesterol). A systematic search yielded 32 articles published between 1980 and April 2007. The studies found that yoga interventions are generally effective in reducing body weight, blood pressure, glucose level and high cholesterol, but only a few studies examined long-term adherence. Additionally, not enough studies included diverse populations at high risk for diabetes and its related common health problems.

Physical Activity Self-Monitoring and Weight Loss: 6-Month Results of the SMART Trial

INTRODUCTION Weight loss has been associated with higher physical activity (PA) levels and frequent dietary self-monitoring. Less is known about how PA self-monitoring affects adherence to PA goals, PA levels, and weight change. METHODS The SMART Trial is a clinical weight loss trial in which 210 overweight adults were randomized equally to one of three arms: 1) paper record (PR), 2) personal digital assistant with self-monitoring software (PDA), and 3) PDA with daily tailored feedback message (PDA + FB). PA self-monitoring and adherence to PA goals were based on entries in weekly submitted diaries. PA levels were measured via self-report by the past 6-month Modifiable Activity Questionnaire at baseline and 6 months. RESULTS Data are presented on 189 participants with complete 6-month PA data (84% female, 77% white, mean age = 47.3 ± 8.8 yr, mean body mass index = 34.1 ± 4.5 kg·m(-2)). Median PA level was 7.96 MET·h·wk(-1) at baseline and 13.4 MET·h·wk(-1) at 6 months, with significant PA increases in all three arms. PDA + FB arm had a higher mean number of weekly self-monitoring entries than the PR arm (3.4 vs 2.4, P = 0.003) and were more likely to maintain high (i.e., 100%) adherence to PA goals over time than the PDA (P = 0.02) or PR arms (P = 0.0003). Both PA self-monitoring and adherence to PA goals were related to higher PA levels at 6 months. A higher mean rate of PA self-monitoring was associated with a greater percentage of weight decrease (ρ = -0.49, P < 0.0001) at 6 months. CONCLUSIONS PA self-monitoring and adherence to PA goals were more likely in participants in the PDA + FB arm and in turn predicted higher PA levels and weight loss.

Utilization of 3-month yoga program for adults at high risk for type 2 diabetes: a pilot study.

Various modes of physical activity, combined with dieting, have been widely recommended to prevent or delay type 2 diabetes. Among these, yoga holds promise for reducing risk factors for type 2 diabetes by promoting weight loss, improving glucose levels and reducing blood pressure and lipid levels. This pilot study aimed to assess the feasibility of implementing a 12-week yoga program among adults at high risk for type 2 diabetes. Twenty-three adults (19 Whites and 4 non-Whites) were randomly assigned to the yoga intervention group or the educational group. The yoga group participated in a 3-month yoga intervention with sessions twice per week and the educational group received general health educational materials every 2 weeks. All participants completed questionnaires and had blood tests at baseline and at the end of 3 months. Effect sizes were reported to summarize the efficacy of the intervention. All participants assigned to the yoga intervention completed the yoga program without complication and expressed high satisfaction with the program (99.2%). Their yoga session attendance ranged from 58.3 to 100%. Compared with the education group, the yoga group experienced improvements in weight, blood pressure, insulin, triglycerides and exercise self-efficacy indicated by small to large effect sizes. This preliminary study indicates that a yoga program would be a possible risk reduction option for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach to reducing cardiometabolic risk factors and increasing exercise self-efficacy for this group.

Wired at a young age: the effect of caffeine and technology on sleep duration and body mass index in school-aged children

INTRODUCTION Two problems affecting school-aged children in the United States are inadequate sleep and an increased prevalence of obesity. The purpose of this study was to quantify media-related technology use and caffeine consumption in order to assess their potential effects on sleep duration and body mass index (BMI) in children. METHODS The study was a secondary analysis of children 6 to 10 years of age (N = 625) from the National Sleep Foundations Sleep in America Poll. Regression analysis was used to assess the relationship between caffeine and technology use, sleep variables, and BMI, adjusting for age, race, gender, and general health. RESULTS Almost 30% (29.5%) of the children consumed a daily caffeinated beverage, and 42.4% had a television in the bedroom. Children who drank caffeinated beverages had 15 fewer minutes of sleep per night than did children who did not drink such beverages (b = -0.27, p = .002). Children with three technology items in their bedroom received 45 fewer minutes of sleep than did children without these items in their bedroom (b = -0.75, p = .010). Having adjusted for variables, only drinking caffeinated beverages was associated with a BMI z score. DISCUSSION The complex relationships between caffeine intake and the use of technology with shortened periods of sleep and increased BMI need further study. Future research should explore how these risk factors for shortened periods of sleep can be modified in this young population.

Leisure-time Physical Activity among Midlife Korean Immigrant Women in the US

The purpose of the study was to investigate the level of leisure-time physical activity (LTPA) among midlife Korean American women and to determine the relationships of LTPA with individual characteristics and behavior-specific cognition and affects. A cross-sectional descriptive study of 152 middle-aged Korean American women in Central Texas was conducted using a health-promotion model of physical activity adapted from Pender’s Health Promotion Model. The results showed that 32% of the participants were not engaged in any form of exercise. The level of acculturation was not significantly related to the amount of physical activity. After age, level of acculturation, education, income, and marital status were controlled, LTPA was significantly associated with perceived benefits and barriers and social support. Physical inactivity, which was common in this group of immigrant women, warrants further rigorous investigation to determine the dynamics of the women’s involvement in more physical activity.

Theories on Immigrant Women's Health

Our purpose in this article is to review theories critically that have been used to explain immigrant womens health based on 4 case studies of Korean immigrant womens experiences in the United States and suggest directions for future development of theories on immigrant womens health. First, 3 existing theories on immigration and health (selective migration, negative effect of immigration, and acculturation) are concisely described. Then, the daily experiences of 4 low-income Korean immigrant women are described in a narrative mode, and the 3 existing theories are critiqued in terms of how they can explain the womens narratives. Finally, implications for future theory development on immigrant womens health experience are proposed based on the discussion.

Sleepiness and health in midlife women: results of the National Sleep Foundation's 2007 Sleep in America poll.

The 2007 Sleep in America™ poll, a random-sample telephone survey, provided data for this study of sleep in community-dwelling women aged 40 to 60 years. The majority of the respondents were post- or perimenopausal, overweight, married or living with someone, and reported good health. A subsample (20%) reported sleepiness that consistently interfered with daily life; the sleepy subsample reported more symptoms of insomnia, restless legs syndrome, obstructive sleep apnea, depression and anxiety, as well as more problems with health-promoting behaviors, drowsy driving, job performance, household duties, and personal relationships. Hierarchal regression showed that sleepiness along with depressive symptoms, medical comorbidities, obesity, and lower education were associated with poor self-rated health, whereas menopause status (pre-, peri- or post-) was not. These results suggest that sleep disruptions and daytime sleepiness negatively affect the daily life of midlife women.

Understanding cultural issues in the diabetes self-management behaviors of Korean immigrants.

Purpose The purpose of this study was to explore potential factors affecting the self-management behaviors of Korean immigrants with type 2 diabetes mellitus (KIT2Ds). Methods A qualitative descriptive design guided this study. Semistructured interviews lasting 45 to 60 minutes were conducted with 20 KIT2Ds in the participants’ preferred language; in all cases, this was Korean. Each interview was audiotaped, transcribed, and analyzed using conventional content analysis. Data analysis was performed in two steps. The data written in Korean were initially analyzed by 3 bilingual researchers. A qualitative researcher then participated in the analysis to refine the findings for presentation to an English-speaking audience while staying true to the data and preserving the nuanced Korean meanings. Results The mean age of the sample was 64. 5 ± 11.6 years (9 men and 11 women). The mean years of staying in the United States and age at diabetes mellitus diagnosis were 23.6 ± 9.7 years and 52.5 ± 12.3 years, respectively. Three major ideas were identified: (1) issues on treatment regimen related to medications and diet, (2) resources that helped or hindered ability to manage diabetes, and (3) the physician-patient relationship. Conclusions Important cultural nuances need to be addressed to better prepare KIT2Ds to manage their diabetes more effectively. A culture-specific program should extend beyond a diabetes self-management education delivered in Korean language. Rather, content and education methods need to consider acculturation effects on diabetes management behaviors.

Insomnia and Physical Activity in Adults With Prediabetes

This secondary analysis study examines the relationship between physical activity and symptoms of insomnia among adults with prediabetes (N = 958) from the 2005-2006 National Health and Nutrition Examination Survey (NHANES). The sample of participants were generally obese, middle-aged, and racially diverse. NHANES questions included symptoms of insomnia, sleep duration, and sleep latency. Body mass index (BMI) was calculated from measured height and weight; at least 2 days of ActiGraph™ activity monitor data determined mean steps walked. Men walked more steps than women; however, women had more insomnia symptoms. There were significant associations between insomnia symptoms and increased sleep latency and decreased sleep duration. Multiple regression analysis showed that younger age, lower BMI, higher self-rated health, high school education, and fewer insomnia symptoms were significantly related to increased steps walked. The findings indicate that insomnia in adults with prediabetes may be a barrier to their adapting an active lifestyle.