Myles D. Young

Effectiveness of male-only weight loss and weight loss maintenance interventions: a systematic review with meta-analysis

The objectives of this systematic review were to investigate the effectiveness of male‐only weight loss and weight loss maintenance interventions and to identify intervention characteristics associated with effectiveness. In May 2011, a systematic literature search with no date restrictions was conducted across eight databases. Twenty‐four articles describing 23 studies met the eligibility criteria. All studies included a weight loss intervention and four studies included an additional weight loss maintenance intervention. Study quality was mostly poor for weight loss studies (median = 3/10, range = 1–9) and weight loss maintenance studies (median = 3.5/10, range = 1–6). Twenty‐three of 31 individual weight loss interventions (74%) from the eligible studies were considered effective. Meta‐analysis revealed a significant difference in weight change favouring weight loss interventions over no‐intervention controls at the last reported assessment (weighted mean difference −5.66 kg [−6.35, −4.97], Z = 16.04 [P < 0.00001]). Characteristics common to effectiveness were younger sample (mean age ≤42.8 years), increased frequency of contact (>2.7 contacts/month), group face‐to‐face contact and inclusion of a prescribed energy restriction. Preliminary evidence suggests men‐only weight loss programmes may effectively engage and assist men with weight loss. However, more high‐quality studies are urgently needed to improve the evidence base, particularly for maintenance studies.

Social cognitive theory and physical activity: a systematic review and meta-analysis.

This review investigated three research questions (i) What is the utility of social cognitive theory (SCT) to explain physical activity (PA)?; (ii) Is the effectiveness of SCT moderated by sample or methodological characteristics? and (iii) What is the frequency of significant associations between the core SCT constructs and PA? Ten electronic databases were searched with no date or sample restrictions. Forty‐four studies were retrieved containing 55 SCT models of PA. Methodological quality was assessed using a standardized tool. A random‐effects meta‐analysis revealed that SCT accounted for 31% of the variance in PA. However, methodological quality was mostly poor for these models. Methodological quality and sample age moderated the PA effect size, with increases in both associated with greater variance explained. Although self‐efficacy and goals were consistently associated with PA, outcome expectations and socio‐structural factors were not. This review determined that SCT is a useful framework to explain PA behaviour. Higher quality models explained more PA variance, but overall methodological quality was poor. As such, high‐quality studies examining the utility of SCT to explain PA are warranted.

Targeted Health Behavior Interventions Promoting Physical Activity: A Conceptual Model.

This article presents a conceptual model illustrating a targeted approach to the design and delivery of health behavior interventions that focus on physical activity promotion. We hypothesize that researchers who i) enhance the sociocultural relevance of their core intervention components and ii) recognize the unique contributions of both intervention design and delivery will experience greater intervention engagement and improved outcomes.

Impact of self-help weight loss resources with or without online support on the dietary intake of overweight and obese men: The SHED-IT randomised controlled trial

BACKGROUND Obese men are more likely to have poor dietary patterns compared to women, increasing diet-related chronic disease risk. The impact of a male-only weight loss intervention on dietary intakes is under-evaluated. The aim was to determine whether overweight/obese men randomised to self-help paper-based resources with or without online support, achieved greater improvements in diet compared with Wait-list controls at 3 and 6 months following a gender tailored weight-loss intervention. METHODS Dietary intake was assessed using a 120-item semi-quantitative food frequency questionnaire (FFQ), in a secondary analysis of a three-arm weight loss RCT grounded in Social Cognitive Theory; (1) RESOURCES: gender-tailored weight loss resources (DVD, handbooks, pedometer, tape measure); (2) Online: resources plus website and efeedback, (3) Wait-list control. RESULTS Energy, total fat, saturated fat, and carbohydrate intakes decreased in the online group, which differed significantly from controls at 3- and 6-month follow-up (P<0.05). There was a significant reduction in energy, fat and carbohydrate intakes in the Resource group at 3 and 6 months, but no difference from controls (P>0.05). In the online group there was an increase in %energy from core foods and decrease in %energy from energy-dense nutrient-poor foods (P<0.05) that was significantly different compared to controls at 3 and 6 months (P<0.05). CONCLUSION Results suggest that men randomised to the SHED-IT intervention arms were able to implement key dietary messages up to 6 months compared to controls. Future interventions should include targeted and gender-tailored messages as a strategy to improve mens dietary intake within weight loss interventions.

Efficacy of the Type 2 Diabetes Prevention Using LifeStyle Education Program RCT

INTRODUCTION Self-administered lifestyle interventions have been suggested as an alternative to face-to-face delivery modes, although their efficacy remains uncertain. The aim of this study was to evaluate the efficacy of the Type 2 diabetes mellitus Prevention Using LifeStyle Education (PULSE) Program, a self-administered and gender-tailored lifestyle intervention for men at high risk for developing Type 2 diabetes mellitus. DESIGN/SETTING A 6-month, assessor-blinded, parallel-group RCT was conducted at the University of Newcastle, Australia in 2012-2013. PARTICIPANTS Men (aged 18-65 years, BMI 25-40 kg/m(2), high risk for developing Type 2 diabetes mellitus) were stratified by age (<50 and >50 years) and BMI category (25.0-29.9, 30.0-35.9, and 35.0-40 kg/m(2)) and individually randomized (1:1 ratio) to the intervention (n=53) or waitlist control groups (n=48). INTERVENTION The intervention group received the PULSE Program, which contained print and video resources on weight loss (Self-Help, Exercise and Diet using Internet Technology [SHED-IT] Weight Loss Program), diet modification, and exercise for Type 2 diabetes mellitus prevention. The waitlist control group received no information until 6 months. MAIN OUTCOME MEASURES Data were collected from September 2012 to September 2013 and analyzed in 2014-2015. Linear mixed models (intention-to-treat) were used to determine group X time interactions (differences between groups in changes over time) at 6 months for the primary outcome (weight), glycated hemoglobin, and several secondary outcomes (significance level, p<0.05). RESULTS Differences between groups in mean changes from baseline to 6 months (group × time interaction) favored the intervention over control group for weight loss (-5.50 kg, 95% CI=-7.40 kg, -3.61 kg, p<0.001, Cohens d=1.15), glycated hemoglobin (-0.2%, 95% CI=-0.3%, -0.1%, p=0.002, d=0.64), and BMI, waist circumference, body fat percentage, aerobic fitness, and lower body muscular fitness (all p<0.05). No group × time effects were observed for fasting plasma glucose, upper body muscular fitness, physical activity, or energy intake. CONCLUSIONS The PULSE Program improved several Type 2 diabetes mellitus risk factors in men, including weight and glycated hemoglobin. These findings provide evidence for a self-administered and gender-tailored lifestyle intervention, which has potential for dissemination in community settings.

A systematic review of SNAPO (Smoking, Nutrition, Alcohol, Physical activity and Obesity) randomized controlled trials in young adult men.

OBJECTIVES To investigate the effectiveness of Smoking, Nutrition, Alcohol, Physical activity and Obesity (SNAPO) interventions in young men exclusively. The secondary aim was to evaluate the recruitment, retention and engagement strategies. METHODS A search with no date restrictions was conducted across seven databases. Randomized controlled trials recruiting young men only (aged 18-35 years) into interventions targeting any SNAPO risk factors were included. RESULTS Ten studies were included (two nutrition, six alcohol use, two targeting multiple SNAPO risk factors). Six studies (two nutrition, three alcohol use and one targeting multiple SNAPO risk factors) demonstrated significant positive short-term intervention effects, but impact was either not assessed beyond the intervention (n=3), had short-term follow-up (≤6 months) (n=2) or not sustained beyond six months (n=1). Overall, a high risk of bias was identified across studies. Only one study undertook a power calculation and recruited the required sample size. Adequate retention was achieved in three studies. Effectiveness of engagement strategies was not reported in any studies. CONCLUSIONS Despite preliminary evidence of short-term effectiveness of SNAPO interventions in young men, few studies characterized by a high risk of bias were identified. High quality SNAPO interventions for young men are warranted.

Effectiveness of interventions with a dietary component on weight loss maintenance: a systematic review

Background Prevention of weight regain after weight loss is a major challenge. Studies employing passive follow up of weight loss maintenance indicate that 50‐80% of participants gradually regain all their lost weight and 50% of this weight regain occurs within the first year. This has led to the development of active weight loss maintenance programs which provide specific interventions to try and prevent this weight regain. To date there is no consensus or clear understanding of the components or strategies necessary for a successful weight loss maintenance intervention. Previous reviews have concluded that pharmacotherapy and group support are most effective for weight loss maintenance. However, prolonged use of pharmacotherapy for weight loss maintenance may be unsafe and providing support, whether face‐to‐face or by telephone contact, may be unsustainable in the longer term. Therefore, an understanding of the effectiveness of interventions with a specific dietary component for weight loss maintenance following weight loss is important, and a review focused on this strategy is required. Objectives The primary objective of this systematic review was to assess the effectiveness of weight loss maintenance interventions that included a specific diet strategy on prevention of weight regain following weight loss. Inclusion criteria Types of participants Study eligibility criteria consisted of those with weight loss maintenance interventions trialed on participants who had recently lost weight, usually as part of a prior weight loss intervention study component, and with participants ≥18 years with a body mass index >24.9 kg/m2prior to weight loss. Studies were considered if the participants had existing co‐morbidities associated with overweight and obesity; however, they were excluded if participants had major medical problems or psychological illness. Types of intervention(s) Weight loss maintenance intervention strategies considered eligible were manipulation of a specific dietary component including prescribed diets, guidelines, advice and/or support to adhere to a dietary prescription. Types of studies Only randomized controlled trial study designs were considered. Types of outcomes The primary outcome measures were weight change, body mass index change, waist circumference change and body fat change. Search strategy Published and unpublished studies in the English language from 1970 to January 2012 were identified from six electronic databases. Methodological quality Methodological quality was assessed by two independent reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta‐Analysis of Statistics Assessment and Review Instrument. Data collection Data were extracted using the JBI data extraction form for experimental studies and included participant characteristics, intervention characteristics, study retention rates, and weight outcomes (weight change; kg or %, body mass index, waist circumference). Data synthesis The impact of interventions on weight outcomes was described in a narrative format within each group of studies. The effectiveness of weight loss maintenance interventions was also assessed using the criteria of maintenance of ≥5% of initial weight loss. When studies were sufficiently similar and results were reported as either change scores or final values, and presented as means with standard deviations, data were pooled in a meta‐analysis. Results Sixty‐four articles representing 56 studies were included in this review. Twenty seven studies prescribed a diet intervention, 11 meal replacements, two re‐feeding time and type, and 16 support delivery mode interventions. Of the 56 studies, only 14 reported significant results for weight loss maintenance (Diet n=6, Meal replacements, n=1, Re‐feeding n=1, Support delivery mode n=6). Conclusions Currently there are many weight loss maintenance interventions being trialed but few have been found to be effective at maintaining >5% of initial weight loss. Whether this is due to the intervention itself being ineffective or simply the lack of reporting of this outcome, it is clear that more studies are needed to address this issue. Implications for practice To facilitate long‐term maintenance of lost weight, health professionals need to advise clients that a specific weight loss maintenance strategy is needed following initial weight loss. Further evidence is required in terms of which intervention components are most effective. Implications for research To strengthen the current evidence base on weight loss maintenance interventions, additional high quality randomized controlled trials that closely adhere to the Consolidated Standards of Reporting Trials guidelines are required. Studies investigating different approaches to achieving a long‐term reduction in energy intake are needed along with evaluation of different approaches to providing support for behavior change during weight loss maintenance.

Compliance to step count and vegetable serve recommendations mediates weight gain prevention in mid-age, premenopausal women. Findings of the 40-Something RCT.

The 40-Something RCT aimed to determine if a 12-month health professional-led intervention could modify diet and physical activity behaviour for obesity prevention, in 44-50 year old, non-obese (BMI = 18.5-29.9 kg/m(2)) premenopausal women. Women were monitored for an additional 12 months to determine if effects could be maintained. This paper aimed to explore dietary and physical activity behavioural mediators hypothesised to be causally associated with weight change. Fifty-four women were randomised to a Motivational Interviewing Intervention (MI) (n = 28; five health professional consultations) or a Self-Directed Intervention (n = 26; written advice). Compliance to 10 study recommendations was measured at three months by a four-day weighed food and physical activity record including pedometer-measured step counts, self-reported exercise minutes and sitting time. The 10 compliance scores were independently assessed in mediation models for 12- and 24-month weight change. The MI effect on step count was an increase of 0.99 points on the 10-point compliance scale (p ≤ 0.01). This MI effect on step count significantly mediated the 12 and 24 month effect on weight (12 months AB = -0.74, 95%CI = -1.95, -0.14; 24 months AB = -1.06, 95% CI = -2.56, -0.36), accounting for 37.23% and 53.79% of the effect, respectively. The MI effect on vegetable serves was an increase of 1.50 points on the compliance scale (p = 0.02). The MI effect on vegetable compliance significantly mediated the effect on weight at 24 months (AB = -0.54, 95% CI = -1.50, -0.04), accounting for 24.92% of the effect. The remaining eight dietary and physical activity compliance scores did not significantly mediate weight loss. Encouraging women to take 10,000 steps and eat five vegetable serves per day may be a promising strategy to achieve long-term weight control at mid-life.

Efficacy of a gender‐tailored intervention to prevent weight regain in men over 3 years: A weight loss maintenance RCT

To examine whether a gender‐tailored weight loss maintenance (WLM) program could reduce mens weight regain following weight loss.

The Influence of Fathers on Children’s Physical Activity and Dietary Behaviors: Insights, Recommendations and Future Directions

Purpose of ReviewAlthough fathers have an important influence on their children’s well-being, their unique influence on child lifestyle behaviors has been largely overlooked in the literature. To inform and encourage future research, this paper provides an overview of existing studies that have examined the influence of fathers on the physical activity and dietary behaviors of their children.Recent FindingsWhile the available data indicate that fathers’ behaviors and parenting practices likely play an important role in promoting healthy behaviors in children, the evidence base is limited by a reliance on observational designs and small, ungeneralizable samples.SummaryThis paper also provides a summary of the methods, research findings, and experiential insights we have gained while conducting the “Healthy Dads, Healthy Kids” randomized controlled trials, which tested the efficacy and effectiveness of a socio-culturally targeted program that engages fathers to improve their own health and the health of their children. The paper concludes with a series of recommendations for recruiting and engaging fathers and a summary of directions for future research.