Lindsay Dillon

A Text Message-Based Intervention for Weight Loss: Randomized Controlled Trial

Background To our knowledge, no studies have evaluated whether weight loss can be promoted in overweight adults through the use of an intervention that is largely based on daily SMS (Short Message Service: text) and MMS (Multimedia Message Service: small picture) messages transmitted via mobile phones. Objective This paper describes the development and evaluation of a text message–based intervention designed to help individuals lose or maintain weight over 4 months. Methods The study was a randomized controlled trial, with participants being exposed to one of the following two conditions, lasting 16 weeks: (1) receipt of monthly printed materials about weight control; (2) an intervention that included personalized SMS and MMS messages sent two to five times daily, printed materials, and brief monthly phone calls from a health counselor. The primary outcome was weight at the end of the intervention. A mixed-model repeated-measures analysis compared the effect of the intervention group to the comparison group on weight status over the 4-month intervention period. Analysis of covariance (ANCOVA) models examined weight change between baseline and 4 months after adjusting for baseline weight, sex, and age. Results A total of 75 overweight men and women were randomized into one of the two groups, and 65 signed the consent form, completed the baseline questionnaire, and were included in the analysis. At the end of 4 months, the intervention group (n = 33) lost more weight than the comparison group (−1.97 kg difference, 95% CI −0.34 to −3.60 kg, P = .02) after adjusting for sex and age. Intervention participants’ adjusted average weight loss was 2.88 kg (3.16%). At the end of the study, 22 of 24 (92%) intervention participants stated that they would recommend the intervention for weight control to friends and family. Conclusions Text messages might prove to be a productive channel of communication to promote behaviors that support weight loss in overweight adults. Trial Registration Clinicaltrials.gov NCT00415870; http://clinicaltrials.gov/ct2/show/NCT00415870 (Archived by WebCite at http://www.webcitation.org/5dnolbkFt)

Outcomes of a 12-month web-based intervention for overweight and obese men

BackgroundThis study assessed the effect of a 1-year internet-based weight loss intervention for men.MethodsFour hundred forty-one overweight and obese men were randomized to intervention or delayed treatment. Participants completed a Web-based assessment of diet and physical activity behaviors and weekly tailored Web modules addressing weight-related behaviors.ResultsAt 12 months compared to controls, intervention men decreased percent of energy from saturated fat and increased grams of fiber and fruit/vegetable servings per 1.000 kcal (p values < 0.001) and walked 16 min more per day (p < 0.05). No between-group differences in body mass index (BMI), weight, or waist circumference were seen, but among completers, men in the highest tertile of intervention participation had lower weight (98.74 vs. 102.37 kg), BMI (32.38 vs. 33.46), and waist circumference (42.17 vs. 43.47 cm) compared to men who participated less often.ConclusionsThe intervention improved diet and activity behaviors, but weight loss occurred only for those with the highest adherence.

Preparing Adolescents With Chronic Disease for Transition to Adult Care: A Technology Program

BACKGROUND: Adolescents with chronic disease (ACD) must develop independent disease self-management and learn to communicate effectively with their health care team to transition from pediatric to adult-oriented health care systems. Disease-specific interventions have been implemented to aid specific ACD groups through transition. A generic approach might be effective and cost-saving. METHODS: Eighty-one ACD, aged 12 to 20 years, were recruited for a randomized clinical trial evaluating an 8-month transition intervention (MD2Me). MD2Me recipients received a 2-month intensive Web-based and text-delivered disease management and skill-based intervention followed by a 6-month review period. MD2Me recipients also had access to a texting algorithm for disease assessment and health care team contact. The intervention was applicable to adolescents with diverse chronic illnesses. Controls received mailed materials on general health topics. Disease management, health-related self-efficacy, and health assessments were performed at baseline and at 2 and 8 months. Frequency of patient-initiated communications was recorded over the study period. Outcomes were analyzed according to assigned treatment group over time. RESULTS: MD2Me recipients demonstrated significant improvements in performance of disease management tasks, health-related self-efficacy, and patient-initiated communications compared with controls. CONCLUSIONS: Outcomes in ACD improved significantly among recipients of a generic, technology-based intervention. Technology can deliver transition interventions to adolescents with diverse chronic illnesses, and a generic approach offers a cost-effective means of positively influencing transition outcomes. Further research is needed to determine whether improved short-term outcomes translate into an improved transition for ACD.

Transition to Adult Care: Systematic Assessment of Adolescents with Chronic Illnesses and their Medical Teams

OBJECTIVE To examine the process of transition from pediatric to adult health care services from the perspectives of young adults with chronic disease and both pediatric and adult health care providers. STUDY DESIGN A qualitative approach using focus-group interviews was performed to investigate transition experiences. Novel games were also used to generate data. Content and narrative analyses of interview transcripts were performed. RESULTS We conducted 6 focus groups with 10 young adults who had chronic disease and with 24 health care providers. Content analysis yielded 3 content domains: (1) transition experiences in the context of relationships among patients, parents, and health care providers; (2) differences between pediatric and adult-oriented medicine and how these differences inhibit or facilitate transition; and (3) identification of transition services that should be provided to young patients who have chronic disease. CONCLUSION This study demonstrates the need for gradual transfer of disease management from parent to child and the need for better communication between adult and pediatric services during the transition process. Pediatric medicine and adult medicine represent different subcultures; acknowledging these differences may improve cooperation during transition from pediatric to adult providers. Young-adult patients with chronic disease embrace the use of technology for specific interventions to improve the transition experience.

A theory-based framework for evaluating exergames as persuasive technology

Exergames are video games that use exertion-based interfaces to promote physical activity, fitness, and gross motor skill development. The purpose of this paper is to describe the development of an organizing framework based on principles of learning theory to classify and rank exergames according to embedded behavior change principles. Behavioral contingencies represent a key theory-based game design principle that can be objectively measured, evaluated, and manipulated to help explain and change the frequency and duration of game play. Case examples are presented that demonstrate how to code dimensions of behavior, consequences of behavior, and antecedents of behavior. Our framework may be used to identify game principles which, in the future, might be used to predict which games are most likely to promote adoption and maintenance of leisure time physical activity.

Fit4Life: A weight loss intervention for children who have survived childhood leukemia

Children surviving acute lymphoblastic leukemia (ALL) are at increased risk for overweight and obesity over that of the general population. Whether a generic or tailored approach to weight management is needed for cancer survivors has yet to be tested.

Feasibility and effectiveness of an automated bilingual text message intervention for weight loss: pilot study.

Background Little is known about the feasibility and acceptability of tailored text message based weight loss programs for English and Spanish-language speakers. Objective This pilot study evaluated the feasibility, acceptability, and estimated impact of a tailored text message based weight loss program for English and Spanish-language speakers. The purpose of this pilot study was to inform the development of a full-scale randomized trial. Methods There were 20 overweight or obese participants (mean age 40.10, SD 8.05; 8/20, 40% male; 9/20, 45% Spanish-speakers) that were recruited in San Diego, California, from March to May 2011 and evaluated in a one-group pre/post clinical trial. For 8 weeks, participants received and responded to 3-5 text messages daily sent from a fully automated text messaging system. They also received printed weight loss materials and brief 10-15 minute weekly counseling calls. To estimate the impact of the program, the primary outcome was weight (kg) measured during face-to-face measurement visits by trained research staff. Pre and post differences in weight were analyzed with a one-way repeated measures analysis of variance. Differences by language preference at both time points were analyzed with t tests. Body mass index and weight management behaviors also were examined. Feasibility and acceptability were determined by recruitment success, adherence (ie, percentage of replies to interactive text messages and attrition), and participant satisfaction. Results Participants who completed the final assessment (N=18) decreased body weight by 1.85 kg (F 1,17=10.80, P=.004, CI∆ 0.66-3.03, η2=0.39). At both time points, there were no differences in weight by language preference. Participants responded to 88.04% (986/1120) of interactive text messages, attrition rate was 10% (2/20), and 94% (19/20) of participants reported satisfaction with the program. Conclusions This fully automated text message based weight program was feasible with English and Spanish-speakers and may have promoted modest weight loss over an 8-week period. Trial Registration Clinicaltrials.gov NCT01171586; http://clinicaltrials.gov/ct2/show/NCT01171586 (Archived by WebCite at http://www.webcitation.org/6Ksr6dl7n).

Acute glucoregulatory and vascular outcomes of three strategies for interrupting prolonged sitting time in postmenopausal women: A pilot, laboratory-based, randomized, controlled, 4-condition, 4-period crossover trial.

Background Prolonged sitting is associated with cardiometabolic and vascular disease. Despite emerging evidence regarding the acute health benefits of interrupting prolonged sitting time, the effectiveness of different modalities in older adults (who sit the most) is unclear. Methods In preparation for a future randomized controlled trial, we enrolled 10 sedentary, overweight or obese, postmenopausal women (mean age 66 years ±9; mean body mass index 30.6 kg/m2 ±4.2) in a 4-condition, 4-period crossover feasibility pilot study in San Diego to test 3 different sitting interruption modalities designed to improve glucoregulatory and vascular outcomes compared to a prolonged sitting control condition. The interruption modalities included: a) 2 minutes standing every 20 minutes; b) 2 minutes walking every hour; and c) 10 minutes standing every hour. During each 5-hr condition, participants consumed two identical, standardized meals. Blood samples, blood pressure, and heart rate were collected every 30 minutes. Endothelial function of the superficial femoral artery was measured at baseline and end of each 5-hr condition using flow-mediated dilation (FMD). Participants completed each condition on separate days, in randomized order. This feasibility pilot study was not powered to detect statistically significant differences in the various outcomes, however, analytic methods (mixed models) were used to test statistical significance within the small sample size. Results Nine participants completed all 4 study visits, one participant completed 3 study visits and then was lost to follow up. Net incremental area under the curve (iAUC) values for postprandial plasma glucose and insulin during the 5-hr sitting interruption conditions were not significantly different compared to the control condition. Exploratory analyses revealed that the 2-minute standing every 20 minutes and the 2-minute walking every hour conditions were associated with a significantly lower glycemic response to the second meal compared to the first meal (i.e., condition-matched 2-hour post-lunch glucose iAUC was lower than 2-hour post-breakfast glucose iAUC) that withstood Bonferroni correction (p = 0.0024 and p = 0.0084, respectively). Using allometrically scaled data, the 10-minute standing every hour condition resulted in an improved FMD response, which was significantly greater than the control condition after Bonferroni correction (p = 0.0033). Conclusion This study suggests that brief interruptions in prolonged sitting time have modality-specific glucoregulatory and vascular benefits and are feasible in an older adult population. Larger laboratory and real-world intervention studies of pragmatic and effective methods to change sitting habits are needed. Trial registration ClinicalTrials.gov NCT02743286.

Planned care for obesity and cardiovascular risk reduction using a stepped-down approach: A randomized-controlled trial

Primary care-based approaches to address concurrent obesity and cardiovascular disease risk factors (CVDRFs) that begin with a high intensity intervention that is subsequently decreased (i.e., stepped-down) if weight loss is achieved have not been rigorously examined. Our study is a 20-month, single-blind randomized controlled trial at five primary care clinics in San Diego, CA, in 2013, where 262 obese adults (aged 25-70 years; 32.1% male; 59.2% white) with at least one CVDRF were enrolled into planned care for obesity and risk reduction (PCORR) using a stepped-down approach or enhanced usual care (EUC). All patients received physician recommendations for weight loss and CVDRFs. EUC patients (n = 132) received an individual session with a health educator every 4 months. PCORR patients (n = 130) received individual and group sessions (in-person, mail, telephone, and email) in three steps, characterized by less contact if success was achieved. At 20 months, 40.7%, 23.8%, and 15.4% of PCORR patients were in steps 1, 2, and 3, respectively (25.2% were lost to follow-up). PCORR resulted in a between-group difference in reduction in body weight of 6.1% [95% CI, 5.3 to 6.9] compared to EUC 2.8% [95% CI, 2.0 to 3.6] p = 0.007, with a greater reduction in BMI (35.2 [95% CI, 34.4 to 35.9] to 33.7 [95% CI, 32.9 to 34.5] kg/m2) than EUC (36.0 [95% CI, 35.3 to 36.8] to 35.1 [95% CI, 34.3 to 35.9] kg/m2), as indicated by a significant treatment by time interaction (p = 0.009). PCORR resulted in greater weight loss over 20 months than EUC. TRIAL REGISTRATION ClinicalTrials.gov, NCT01134029.

Abstract 1368: Parenting considerations in the management of overweight and obese childhood ALL survivors.

BACKGROUND: Childhood acute lymphoblastic leukemia (ALL) survivors are at a higher risk for obesity and overweight than even the general pediatric population. Obesity risk has been linked to certain parenting (permissive and authoritarian) styles and to lack of parental support for weight-related behaviors. We thus sought to evaluate the potential contribution of parenting behaviors and styles to weight related issues and depression among overweight and obese children who have survived ALL. METHODS: Surveys on parenting styles, behaviors, communication styles, and parental support for weight management behaviors were performed by the primary parents of overweight and obese youth recruited for a clinical trial of a weight management program among childhood ALL survivors aged 8-18 years at three tertiary care pediatric institutions. In addition, the Childhood Depression Inventory was performed by the recruited children and baseline demographics from both children and parents were collected. Distribution and correlation analyses of survey results and collected baseline data were performed. RESULTS: Thirty five overweight (20%) and obese (80%) children recruited to date comprised 43% male, median (IQR) age of 13 (10,16) years, median BMI % of 98 (95,99)% and 89% Hispanic. The corresponding primary parent population consisted of 89% women, median age of 42 (38,48) years, median BMI of 33 (28,40) kg/m2 (60% obese, 26% overweight), and 89% Hispanic. While the majority (97%) of parents reported an authoritative parenting style, there were variations in the amount of permissive and dysfunctional parenting reported. Parenting verbosity in reaction to misbehavior was moderately associated with increased baseline child BMI percentile (r=0.37, p=0.03). Authoritarian parenting style moderately correlated with parental support for physical activity (specifically walking and biking) for the entire cohort (r=0.36, p=0.03). However, overall, parenting styles did not specifically correlate with support for weight management behaviors or with age and gender-matched child BMI percentiles. Parental over-reactivity correlated with higher child depression rating scores (r=0.35, p=0.04) while parental granting of autonomy was associated with lower depression rating scores (r=-0.35, p DISCUSSION: We did not observe a preponderance of parenting styles associated with greater weight status in children among overweight and obese youth with ALL. However, specific parenting styles and behaviors were related to child weight status, parental weight management support, and depression ratings among overweight and obese ALL child survivors. These data confirm the important role of parents in weight management among young childhood ALL survivors. Citation Format: Jeannie S. Huang, Laura Terrones, Maria Chang, Lindsay Dillon. Parenting considerations in the management of overweight and obese childhood ALL survivors. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1368. doi:10.1158/1538-7445.AM2013-1368