Nicolaas P. Pronk

Binge eating disorder, weight control self-efficacy, and depression in overweight men and women

OBJECTIVE: To examine binge eating, depression, weight self-efficacy, and weight control success among obese individuals seeking treatment in a managed care organization.DESIGN: Gender-stratified analyses of associations between binge eating, depression, weight self-efficacy, and weight change, using data from a randomized clinical trial that compared low-cost telephone-based, mail-based, and usual care interventions for weight loss.SUBJECTS: A total of 1632 overweight individuals (460 men, 1172 women; mean age: 50.7 y; mean body mass index: 34.2 kg/m2) were recruited from a large Midwestern US managed care organization.MEASUREMENTS: Height and weight were measured by study personnel at baseline, and self-reported weight was assessed at 6 and 12 months; self-reported depression status, binge eating, and self-efficacy for weight control were assessed at baseline.RESULTS: Lifetime prevalence rates for depression and probable binge eating disorder were high. Weight self-efficacy was inversely related to weight in both men and women. For women, depression was associated with lower weight self-efficacy and higher body weight. Women reporting depression or lower weight self-efficacy at baseline had less weight loss success at 6 and 12 months. Depression, binge eating disorder, and weight self-efficacy were not significantly associated with weight loss success in men.CONCLUSION: Negative emotional states are highly prevalent and predict poor treatment outcomes, particularly for obese women. As obese women with clinical depression typically are excluded from intervention studies, further research on how to address the intersection of obesity intervention and mood management may be warranted.

The association between work performance and physical activity, cardiorespiratory fitness, and obesity

Learning ObjectivesList the baseline characteristics of the nearly 700 individuals participating in this study of how modifiable lifestyle-related risk factors relate to job performance.Define whether, and in what ways, risk factor status was associated with work performance.Explain what these findings mean about choosing appropriate interventions to lessen absenteeism and improve job performance. The purpose of this study was to test the association between lifestyle-related modifiable health risks (physical activity, cardiorespiratory fitness, and obesity) and work performance. Data were obtained from 683 workers. Dependent variables included number of work loss days, quantity and quality of work performed, overall job performance, extra effort exerted, and interpersonal relationships. Results indicated that higher levels of physical activity related to reduced decrements in quality of work performed and overall job performance; higher cardiorespiratory fitness related to reduced decrements in quantity of work performed, and a reduction in extra effort exerted to perform the work; obesity related to more difficulty in getting along with coworkers; severe obesity related to a higher number of work loss days. It is concluded that lifestyle-related modifiable health risk factors significantly impact employee work performance.

Reducing Occupational Sitting Time and Improving Worker Health: The Take-a-Stand Project, 2011

Background Prolonged sitting time is a health risk. We describe a practice-based study designed to reduce prolonged sitting time and improve selected health factors among workers with sedentary jobs. Community Context We conducted our study during March–May 2011 in Minneapolis, Minnesota, among employees with sedentary jobs. Methods Project implementation occurred over 7 weeks with a baseline period of 1 week (period 1), an intervention period of 4 weeks (period 2), and a postintervention period of 2 weeks (period 3). The intervention group (n = 24) received a sit-stand device during period 2 designed to fit their workstation, and the comparison group (n = 10) did not. We used experience-sampling methods to monitor sitting behavior at work during the 7 weeks of the project. We estimated change scores in sitting time, health risk factors, mood states, and several office behaviors on the basis of survey responses. Outcome The Take-a-Stand Project reduced time spent sitting by 224% (66 minutes per day), reduced upper back and neck pain by 54%, and improved mood states. Furthermore, the removal of the device largely negated all observed improvements within 2 weeks. Interpretation Our findings suggest that using a sit-stand device at work can reduce sitting time and generate other health benefits for workers.

Health promotion programs, modifiable health risks, and employee absenteeism.

This literature review demonstrates that the health risks and failure of employees to participate in fitness and health promotion programs are associated with higher rates of employee absenteeism. When determining how to manage absenteeism, employers should carefully consider the impact that health promotion programs can have on rates of absenteeism and other employee-related expenses.

Mail and phone interventions for weight loss in a managed-care setting: Weigh-To-Be one-year outcomes

OBJECTIVE: To describe methods, recruitment success, and 1-y results of a study evaluating the effectiveness of phone- and mail-based weight-loss interventions in a managed care setting.DESIGN: Randomized clinical trial with three groups, that is, usual care, mail intervention, and phone intervention.SUBJECTS: In total, 1801 overweight members of a managed-care organization (MCO).MEASUREMENTS: Height, weight, medical status, and weight-loss history were measured at baseline. Participation in intervention activities was monitored for 12 months in the two active treatment groups. Self-reported weight was obtained at 6 and 12 months.RESULTS: More individuals assigned to mail treatment started it (88%) than did those assigned to phone treatment (69%). However, program completion rates were higher in the phone (36%) than mail (7%) intervention. The mean weight losses were 1.93, 2.38, and 1.47 kg at 6 months in the mail, phone, and usual care groups, respectively. The differences between the phone and usual care groups were statistically significant. The mean weight losses at 12 months did not differ by treatment group (2.28 kg mail, 2.29 kg phone, and 1.92 kg usual care). Greater weight loss was seen in men, older participants, and those with no prior experience in a weight-loss program. Heavier participants and those who reported current treatment for depression lost less weight.CONCLUSION: Although mail- and phone-based weight-loss programs can be delivered to large numbers of people in an MCO setting, additional work is needed to enhance their clinical efficacy as well as to assess their costs.

Effects of a 10,000 Steps per Day Goal in Overweight Adults

Purpose. This study was designed (1) to examine the effects of a 10,000 steps·d−1 exercise prescription on sedentary, overweight/obese adults, and (2) to examine the effects of adherence on body composition and cardiovascular risk factors. Methods. Fifty-six overweight/obese adults participated in the study. Body composition and cardiovascular risk factors were determined at baseline, 20 weeks, and 36 weeks. Adherence was defined as averaging ≥ 9500 steps·d−1 from week 4 to week 36. Results. 38 participants (68%) wore pedometers daily for 36 weeks and were available for posttesting. Significant improvements were noted in mean values for walking volume (3994 steps·d−1), body weight (–2.4 kg), body mass index (–0.8 kg·m−2), percentage body fat (–1.9%), fat mass (–2.7 kg), waist circumference (–1.8 cm), hip circumference (–1.9 cm) and high-density lipoprotein (3 mg/dl). The adherers had large improvements in body composition measures, whereas the nonadherers showed little or no change in these variables. Discussion. A 10,000 steps·d−1 exercise prescription resulted in weight loss over 36 weeks in previously sedentary, overweight/obese adults. Adherence to the step goal had a marked effect on the outcome.

Changes in physical activity and short-term changes in health care charges: a prospective cohort study of older adults

BACKGROUND Better understanding the impact of changes in physical activity behavior on short-term health care charges may inform resource allocation decisions to increase population levels of physical activity. This study examines the prospective relationship of changes in physical activity status on short-term changes in health care charges for older adults. METHODS A prospective cohort study was done on a stratified random sample of 2,393 adults aged 50 and older enrolled in a Minnesota health plan, predicting changes in resource use between two periods (September 1994 to August 1995 and September 1996 to August 1997) based on billed health care charges. RESULTS After adjustment for age, gender, comorbidity, smoking status, and body mass index, all physical activity states had declining health care charges, relative to those who were consistently inactive. Subjects who increased their physical activity from 0-1 to 3+ days/week had significant declines in their mean annualized total charges (-2,202 dollars, P < 0.01) relative to those who remained inactive. CONCLUSIONS Increased physical activity among older adults is associated with lower health care charges within 2 years, relative to charges for those who were persistently inactive. These cost savings may justify investments in effective interventions to increase physical activity in older adults.

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.

Physical activity promotion as a strategic corporate priority to improve worker health and business performance

BACKGROUND The increasingly sedentary nature of work and its impact on health and productivity indicators demands the promotion of physical activity at the worksite. PURPOSE This paper aims to present considerations for broad-scale application of corporate strategies designed to promote physical activity among employees and their families through employer-sponsored initiatives. APPROACH The benefits of physical activity are multifold, including health and wellbeing and productivity related outcomes. The workplace setting may be leveraged to promote physical activity levels through frequent and sustained exposures to effective interventions that reach employees and, indirectly, their families. Furthermore, employers represent a powerful stakeholder group that should leverage its influence on health policy initiatives designed to create supportive environments inside the workplace as well as the broader community. Specific principles, recommendations for action, and considerations for the prioritization of initiatives are provided based on essential elements for comprehensive programs and health policy initiatives and in the context of a social-ecological model and supportive research. CONCLUSIONS Physical activity promotion at the worksite should be an integrated initiative that measurably improves worker health and enhances business performance.

Short term effects of exercise on plasma lipids and lipoproteins in humans.

SummaryLipids and lipoproteins play a major role in the cascade of events leading up to the manifestations of atherosclerosis as it relates to coronary heart disease (CHD). Exercise-induced changes in the blood lipid profile appear to be therapeutic, an observation favouring the integration of exercise in CHD prevention and treatment programmes. The specific stimuli needed to produce such therapeutic effects are yet to be elucidated; both the repeated, transitory effects of single, isolated exercise sessions and exercise training effects are likely to be involved. The focus of this article is on the acute or short term changes of a single session of exercise on plasma lipids and lipoproteins.The short term, exercise-induced changes in plasma lipids and lipoproteins are reviewed in the context of the role various lipid classifications play in coronary artery disease, the many potentially confounding variables that are ever-present, and the relative effects of gender, exercise modality, and exercise intensity. It is concluded that a single bout of exercise has the potential to induce short term, transient increases in the high density lipoproteins HDL and HDL2 and decreases in triglycerides in men. For women, more research is needed to determine clearly the exercise induced short term changes in plasma lipids and lipoproteins. It appears that duration and intensity of exercise are directly related to the degree of changes observed: bouts of prolonged, intense exercise of sufficient energy expenditure appear to induce decreases in triglycerides and increases in HDL, primarily through HDL2, of greater magnitude and duration. Exercise induced changes in the plasma lipid profile appear to have returned to pre-exercise levels by 48 hours postexercise. Recognising that the underlying physiological mechanisms for changes in lipids and lipoproteins remain inconclusive, the roles of the lipid-regulatory enzymes lipoprotein lipase, lecithin: cholesterol acyltransferase, and hepatic triglyceride lipase are discussed. It is clear that well controlled studies are needed to examine the effects of exercise on short term changes in the blood lipid profile in women.