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Background: Lifestyle interventions can promote improvement in dietary intake and physical activity (PA), on average, by strengthening motivation, self-regulatory efforts, and commitment to behavioral change. However, maintenance of behavioral change is challenging, and slow responders during treatment often experience less overall success. Adaptive intervention sequences tailored to treatment response may be more effective in sustaining behavioral change. Methods: Adults ≥ 21 years old with prediabetes (n = 187) were stratified at week five to the standard Group Lifestyle Balance (GLB) intervention, if they achieved > 2.5% weight loss, or to the augmented intervention GLB Plus (GLB+) at week five, if they did not. At month five, each person in a matched pair was randomly assigned to GLB or GLB + for the extended intervention phase (months 5-12) followed by no study conduct (months 13-18). The primary comparison of interest was the change in outcomes between the standard (GLB followed by GLB) and augmented (GLB + followed by GLB+) intervention sequences post-intervention at 12 - and 18-months using linear mixed effect models. Results: The augmented GLB + intervention sequence reported a decline in the change in self-efficacy for reducing fat intake, self-efficacy for 'sticking to' healthy eating and exercise, and hopeful thought and planning compared to the standard GLB intervention sequence (all P < 0.0167) at 18-months. However, there were no significant differences between these intervention sequences at 18-months in the change in dietary intake or minutes of PA (all P > 0.05). Conclusions: No significant change in behavioral measures across intervention sequences occurred at study end. An 18-month decline in self-efficacy regarding diet and PA and hopeful thought and planning among slow responders following no intervention for six months indicates greater extended care is likely needed. The type of extended care that is most effective for slow treatment responders requires additional research.
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Early slow weight loss during treatment is associated with less weight loss overall. The impact of an augmented intervention designed for early slow weight loss responders compared with a standard diabetes prevention intervention was evaluated following 12 months of treatment and 6 months of no contact. The impact of standard vs. augmented intervention sequences on weight and glycemia also was determined. Adults were ≥21 years old with overweight or obesity and prediabetes (n = 174). Slow responders were stratified to augmented treatment if they failed to achieve >2.5% weight loss (%WL) at Week 5. Matched within-sex pairs of participants were created based on %WL at Month 5 following the intensive intervention phase, and each person within the pair was randomly assigned to treatment for Months 5-12 during the extended intervention phase. Both 12-month interventions included a ≥7%WL goal. Mean 12-month %WL was 5.29% (95% CI: 4.27%-6.31%; P < .0001) and 18-month %WL was 3.34% (95% CI: 2.01%-4.66%; P < .0001) overall. %WL was greater for the standard (9.55%) than the augmented (4.0%) intervention (P = .0001); no differences occurred in weight regain between early and slow responders (P = .9476). No differences occurred in mean %WL at 12 months between the standard and augmented groups after controlling for %WL at Week 5 and sex (P = .23) nor in the change in glycemia (all P > .05). WL following the first month of treatment predicted 12- and 18-month WL success regardless of intervention sequence; however, even early slow responders achieved significant WL during treatment. Further research is needed to support effective WL maintenance for people with prediabetes.
Weight loss is a primary strategy for risk reduction in adults with prediabetes, and early weight loss may indicate weight loss success long-term. Early slow weight loss responders during behavioral treatment may benefit from alternate treatment compared with remaining in a standard diabetes prevention program. An intervention augmented with training in goal setting and problem-solving was implemented among slow weight loss responders following the first month of treatment in the current study. The change in percent weight loss observed in the augmented intervention compared with the standard diabetes prevention intervention was determined at 12 and 18 months from baseline. Both the standard and augmented interventions facilitated significant weight loss at 12 months. Participants who lost more than 2.5% of their weight during the first month of treatment (early responders) lost more weight overall during the study compared with people who were slower to respond. Percent weight loss following the first month of lifestyle intervention and sex predicted percent weight loss at 12 months. Participants regained some weight at 18 months regardless of the treatment group but weighed less than their baseline weight. Both early and slow weight loss responders may benefit from ongoing support following 12 months of treatment to achieve weight loss maintenance.
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Objectives: Males often lose more weight than females during treatment, and early weight loss predicts weight loss longer-term. Yet, mechanisms for sex differences in early weight loss are unknown and were examined in this study.Methods: Adults≥21 years old with overweight or obesity and prediabetes (N=206) participated in a lifestyle intervention and completed baseline psychosocial questionnaires. Percent weight loss, session attendance, and number of days participants self-monitored dietary intake and weight were determined at week 5. Principal components, regression, and mediation analyses were conducted to determine whether weight loss differed by sex and potential mediators of weight change. Results: Mean (±SD) weight loss was greater for males (2.59±1.62%) than females (2.05±1.54%; p=.02). Attendance, self-monitoring, and beliefs regarding disease risk were independent predictors of weight loss (all p<.05) but did not explain sex differences. The association between attendance and weight loss was stronger for males than females (p<.05). Conclusions: Additional research is needed to identify mechanisms that explain sex differences in early weight loss. However, strengthening risk beliefs, attendance, and self-monitoring may promote greater early weight loss for all participants.
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Estado Prediabético , Caracteres Sexuales , Adulto , Humanos , Femenino , Masculino , Adulto Joven , Estilo de Vida , Obesidad/prevención & control , Estado Prediabético/terapia , Pérdida de PesoRESUMEN
Self-regulation can facilitate modifications in lifestyle to promote behavioral change. However, little is known about whether adaptive interventions promote improvement in self-regulatory, dietary, and physical activity outcomes among slow treatment responders. A stratified design with an adaptive intervention for slow responders was implemented and evaluated. Adults ≥ 21 years old with prediabetes were stratified to the standard Group Lifestyle Balance intervention (GLB; n = 79) or the adaptive GLB Plus intervention (GLB + ; n = 105) based on first-month treatment response. Intake of total fat was the only study measure that significantly differed between groups at baseline (P = 0.0071). GLB reported greater improvement in self-efficacy for lifestyle behaviors, goal satisfaction with weight loss, and very active minutes of activity than GLB + (all P < 0.01) at 4-months. Both groups reported significant improvement in self-regulatory outcomes and reduction in energy and fat intake (all P < 0.01). An adaptive intervention can improve self-regulation and dietary intake when tailored to early slow treatment responders.
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Diabetes Mellitus , Estado Prediabético , Adulto , Humanos , Adulto Joven , Estado Prediabético/terapia , Dieta , Diabetes Mellitus/prevención & control , Ejercicio Físico/fisiología , Estilo de VidaRESUMEN
BACKGROUND: Being overweight or obese is a large public health problem, especially in the African American/Black and Hispanic communities. Having a body mass index (BMI) > 25 can lead to chronic health conditions, such as heart disease, stroke, and type 2 diabetes. The transition into adulthood may be an excellent time to intervene due to young adults gaining independence; however, little research has focused on community college students and weight change. The purpose of this randomized controlled trial is to test the efficacy of an intervention tool that is personalized for weight loss through healthy eating and increased physical activity in Black and Hispanic community college students. METHODS: Community college students who identify as Black or Hispanic (N = 256) will be recruited and randomized 1:1 to a 12-month, health coach and smartphone application (app) driven intervention or an attention-control condition. The intervention is implemented by health coaches, trained in a health coach specialty program at a university. The intervention includes a Smartphone app for tracking dietary intake, a Fitbit Inspire 2 for tracking physical activity, and daily personalized text messages from a health coach. The main outcome is percent weight loss at 6- and 12-month follow-up assessments. Secondary outcomes include self-efficacy for eating and physical activity, adherence to self-monitoring, Healthy Eating Index scores, and physical activity levels. DISCUSSION: If the intervention is demonstrated to be efficacious, broader dissemination across college/university campuses to assist young adults to develop sustainable healthy habits may be possible. CLINICALTRIALS: gov Identifier: NCT04412954 R01 Trial Number: 1R01NR018699-02.
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Diabetes Mellitus Tipo 2 , Adulto , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Obesidad/terapia , Sobrepeso/terapia , Pérdida de Peso , Adulto JovenRESUMEN
OBJECTIVE: Some people are slower to respond during lifestyle interventions. An adaptive "rescue" intervention may improve outcomes among slow responders. The impact of a worksite rescue intervention for early slow responders was evaluated. RESEARCH DESIGN AND METHODS: Employees ≥21 years old with prediabetes were stratified to intervention using a 2.5% weight loss (%WL) threshold at week 5. Outcomes were assessed at baseline and at 4 months using mixed-effect and linear regression models. RESULTS: Significant improvement occurred in mean %WL, glycemia, total cholesterol, and triglycerides in the standard compared with the adaptive (Group Lifestyle Balance Plus [GLB+]) intervention (all P≤ 0.01). However, GLB+ participants also experienced a significant reduction in %WL and glycemia (all P < 0.01). The %WL at week 5 significantly predicted %WL at 4 months (P < 0.0001). The between-group difference of 4-month %WL was not significant for someone achieving 2.5%WL at week 5. CONCLUSIONS: Diabetes prevention programs should consider weight loss success following 1 month of treatment and offer a rescue intervention to early slow weight loss responders.
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Diabetes Mellitus , Estado Prediabético , Adulto , Colesterol , Humanos , Estado Prediabético/terapia , Triglicéridos , Pérdida de Peso , Adulto JovenRESUMEN
PURPOSE: The overall purpose of the study was to explore perceptions of family support in diabetes self-management among African American adults with type 2 diabetes. METHODS: A qualitative study using focus group methodology and individual interviews was conducted. Thirty-seven African American adults with type 2 diabetes were recruited in the Midwest, United States. Data were analyzed using qualitative content analysis. RESULTS: Themes emerged from the perspectives of the social interdependence theory. Positive family support included emotional support, instrumental support, and specific information or advice on diabetes management strategies. Positivity, family communication, and healthy eating/meal planning were perceived as helpful family behaviors. Negative support was perceived as intentional or unintentional behaviors. Family members' help in decision-making included goal setting with family member(s) and help in making decisions on diet and exercise. Recommendations included exercise and nutritional programs, support groups, family involvement, and materials and resources. Motivations for attending diabetes programs included involving family members, sharing success stories, seeing positive results, encouraging and caring, and providing incentives. CONCLUSIONS: Intervention programs for African Americans should specifically target challenges in family support, healthy eating, and physical activity at an interpersonal level. Health care providers should assess family roles and family support to facilitate diabetes self-management for African Americans.
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Negro o Afroamericano , Diabetes Mellitus Tipo 2 , Adulto , Diabetes Mellitus Tipo 2/terapia , Grupos Focales , Humanos , Percepción , Apoyo Social , Estados UnidosRESUMEN
BACKGROUND: Racial minority children, particularly from low-income households, are at risk for obesity. Family meals have a protective effect on child nutritional health. However, the current evidence is limited in racial and socioeconomic diversity. The objective of this study was to evaluate the impact of a family meals intervention, Simple Suppers, on improvements in diet and health outcomes from baseline (T0) to post-intervention (T1) in intervention compared to waitlist control participants, and determine retention of change in outcomes among intervention participants at 10-week follow-up (T2). METHODS: Simple Suppers was a 10-week family meals intervention implemented as a 2-group quasi-experimental trial. Ten 90-min lessons were delivered weekly. Data were collected at T0 and T1, and from intervention participants at T2. Participants were racially diverse 4-10 year-old children from low-income households. Setting was a faith-based community center. Main outcomes were daily servings of fruit, vegetables, and sugar-sweetened beverages and diet quality; z-scores for body mass index (BMI), waist circumference, systolic and diastolic blood pressure (BP); weight status categories; food preparation skills; and family meals (frequency of dinner, breakfast, TV viewing during meals, meals in dining area). Generalized linear mixed models (GLMMs) and mixed-effects ordinal regression models were used to assess intervention impact (T0:T1). Paired t-tests examined retention of change among intervention participants (T1:T2). RESULTS: One hundred forty children enrolled and 126 completed T1 (90% retention); 71 of 87 intervention participants completed T2(79% retention). Mean (SD) age was 6.9(1.9) yr, 62% female, 60% Black, and 42% low-income. Intervention vs waitlist controls had higher food preparation skills (p < 0.001) and lower TV viewing during meals (p = 0.04) at T1.There were no group differences in dietary intake or quality or z-scores for BMI, waist circumference, or BP, however intervention versus waitlist controls experienced a greater change toward healthy weight (p = 0.04) At T2, intervention participants demonstrated a retention of improved food preparation skills. CONCLUSIONS: Simple Suppers led to improvements in children's weight status, food preparation skills, and TV viewing during meals, but not diet or z-scores for BMI, waist circumference, or BP. Future research should examine the preventive effects of healthy family mealtime routines in children at greatest risk for obesity. TRIAL REGISTRATION: NCT02923050; Simple Suppers Scale-up (S3); Retrospectively registered on Oct 2016; First participant enrolled on Jan 2015.
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Dieta/estadística & datos numéricos , Familia , Comidas , Obesidad Infantil/prevención & control , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Obesidad Infantil/epidemiología , Evaluación de Programas y Proyectos de Salud , Factores de RiesgoRESUMEN
PURPOSE OF REVIEW: Adaptive behavioral interventions tailor the type or dose of intervention strategies to individuals over time to improve saliency and intervention efficacy. This review describes the unique characteristics of adaptive intervention designs, summarizes recent diabetes-related prevention studies, which used adaptive designs, and offers recommendations for future research. RECENT FINDINGS: Eight adaptive intervention studies were reported since 2013 to reduce sedentary behavior or improve weight management in overweight or obese adults. Primarily, feasibility studies were conducted. Preliminary results suggest that just-in-time adaptive interventions can reduce sedentary behavior or increase minutes of physical activity through repeated prompts. A stepped-down weight management intervention did not increase weight loss compared to a fixed intervention. Other adaptive interventions to promote weight management are underway and require further evaluation. Additional research is needed to target a broader range of health-related behaviors, identify optimal decision points and dose for intervention, develop effective engagement strategies, and evaluate outcomes using randomized trials.
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Terapia Conductista , Conducta Sedentaria , Adulto , Peso Corporal , Humanos , Obesidad/terapia , Sobrepeso/terapia , Pérdida de PesoRESUMEN
IN BRIEF Participants with type 2 diabetes established personalized dietary and physical activity goals as behavioral strategies to reduce cardiovascular risk during a 16-week telephone coaching intervention. People were most likely to attain dietary goals that involved altering the intake of specific foods rather than certain nutrients and were more successful at physical activity goals to increase activity levels rather than to add new types of activity. Barriers to goal success included time management, physical limitations/illness, and social/cultural activities.
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IN BRIEF This article provides a description of mindfulness and mindful eating and addresses the application of mindful eating as a component of diabetes self-management education. Mindful eating helps individuals cultivate awareness of both internal and external triggers to eating, interrupt automatic eating, and eat in response to the natural physiological cues of hunger and satiety. Mindful eating interventions have been effective in facilitating improvement in dysregulated eating and dietary patterns. Through practice over time, eating mindfully can interrupt habitual eating behaviors and provide greater regulation of food choice. More research is needed to determine the long-term impact of mindful eating programs.
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OBJECTIVE: Evaluate adolescent lifestyle patterns to develop more effective health promotion programs. METHODS: An interview approach was employed to gain in-depth understanding of eating and activity behaviors. Adolescents aged 13-18 years (n=43) from clinically normal and obese weight categories were enrolled. Nutrient intake and food group servings were obtained from a food frequency questionnaire. RESULTS: Four participant subgroups were identified and labeled: "Idle, Engaged, Balanced and Working." "Idle" adolescents were sedentary, sometimes napped, and often snacked after dinner. "Engaged" adolescents participated in extra-curricular activities for the majority of their after school hours. "Balanced" adolescents participated in a single after-school activity followed by sedentary time; they consumed meals consistently and often snacked after dinner. "Working" adolescents were the least sedentary with limited sleep duration and inconsistent meals; they often substituted a meal with a snack. Weight status did not differentiate subgroups effectively. CONCLUSIONS: Each group demonstrated at-risk behaviors for obesity. Future programs should consider after-school schedules and use activity and meal pattern assessments, not simply weight status, for program tailoring. PRACTICE IMPLICATIONS: Pediatric health care providers could identify at-risk behaviors through routine assessment of diet and activity patterns in combination with weight monitoring.
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Conducta del Adolescente , Conducta Alimentaria , Estilo de Vida , Obesidad/etiología , Adolescente , Peso Corporal , Ingestión de Energía , Femenino , Promoción de la Salud , Humanos , Entrevistas como Asunto , Masculino , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Evaluate a 16-week decision support and goal-setting intervention to compare diet quality, decision, and diabetes-related outcomes to a control group. METHODS: Adults with type 2 diabetes (n=54) were randomly assigned to an intervention or control group. Intervention group participants completed one in-person motivational interviewing and decision support session followed by seven biweekly telephone coaching calls. Participants reported previous goal attempts and set diet- and/or physical activity-related goals during coaching calls. Control group participants received information about local health care resources on the same contact schedule. RESULTS: There was a significant difference between groups for diabetes empowerment (p=0.045). A significant increase in diet quality, diabetes self-efficacy, and diabetes empowerment, and a significant decrease in diabetes distress and depressive symptoms (all p≤0.05) occurred in the intervention group. Decision confidence to achieve diet-related goals significantly improved from baseline to week 8 but then declined at study end (both p≤0.05). CONCLUSIONS: Setting specific diet-related goals may promote dietary change, and telephone coaching can improve psychosocial outcomes related to diabetes self-management. PRACTICE IMPLICATIONS: Informed shared decision making can facilitate progressively challenging yet attainable goals tailored to individuals' lifestyle. Decision coaching may empower patients to improve self-management practices and reduce distress.
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Técnicas de Apoyo para la Decisión , Diabetes Mellitus Tipo 2/terapia , Dieta para Diabéticos , Tutoría/métodos , Entrevista Motivacional , Teléfono , Adulto , Depresión/epidemiología , Diabetes Mellitus Tipo 2/psicología , Femenino , Hemoglobina Glucada/análisis , Objetivos , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Autoeficacia , Resultado del TratamientoRESUMEN
BACKGROUND: Given the ongoing childhood obesity public health crisis and potential protective effect of family meals, there is need for additional family meals research, specifically experimental studies with expanded health outcomes that focus on the at-risk populations in highest need of intervention. Future research, specifically intervention work, would also benefit from an expansion of the target age range to include younger children, who are laying the foundation of their eating patterns and capable of participating in family meal preparations. The purpose of this paper is to address this research gap by presenting the objectives and research methods of a 10-week multi-component family meals intervention study aimed at eliciting positive changes in child diet and weight status. METHODS: This will be a group quasi-experimental trial with staggered cohort design. Data will be collected via direct measure and questionnaires at baseline, intervention completion (or waiting period for controls), and 10-weeks post-intervention. Setting will be faith-based community center. Participants will be 60 underserved families with at least 1, 4-10 year old child will be recruited and enrolled in the intervention (n = 30) or waitlist control group (n = 30). The intervention (Simple Suppers) is a 10-week family meals program designed for underserved families from racial/ethnic diverse backgrounds. The 10, 90-min program lessons will be delivered weekly over the dinner hour. Session components include: a) interactive group discussion of strategies to overcome family meal barriers, plus weekly goal setting for caregivers; b) engagement in age-appropriate food preparation activities for children; and c) group family meal for caregivers and children. Main outcome measures are change in: child diet quality; child standardized body mass index; and frequency of family meals. Regression models will be used to compare response variables results of intervention to control group, controlling for confounders. Analyses will account for clustering by family and cohort. Significance will be set at p < 0.05. DISCUSSION: This is the first experimentally designed family meals intervention that targets underserved families with elementary school age children and includes an examination of health outcomes beyond weight status. Results will provide researchers and practitioners with insight on evidence-based programming to aid in childhood obesity prevention. TRIAL REGISTRATION: NCT02923050 . Registered 03 October 2016. Retrospectively registered.
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Dieta , Familia , Conducta Alimentaria , Comidas , Índice de Masa Corporal , Peso Corporal , Niño , Preescolar , Femenino , Humanos , Obesidad Infantil/prevención & control , Proyectos de Investigación , Factores SocioeconómicosRESUMEN
PURPOSE: The purpose of this study was to evaluate a 4-month telephone-based goal-setting and decision support intervention among adults with type 2 diabetes mellitus (T2DM) and multiple risk factors for cardiovascular disease (CVD). METHODS: A randomized pretest-posttest control group design was employed. Overweight or obese adults aged 40 to 75 years with T2DM and ≥1 additional CVD risk factor were provided with individualized CVD risk information. At baseline and each biweekly telephone call, the multiple-goal group self-selected both diet- and physical activity-related goals, the single goal group set a single goal, and the control group received information about community health resources. Dietary intake was assessed via a food frequency questionnaire, physical activity via questionnaire, and A1C and blood lipids via fasting fingerstick sample. Between-group differences for clinical (ie, A1C, blood pressure, and blood lipids), physical activity, and dietary variables were evaluated using Kruskal-Wallis, Mann-Whitney U, analysis of variance, and t tests. RESULTS: From pre- to postintervention, the single-goal group demonstrated significant improvement in systolic blood pressure and intake of servings of fruits, vegetables, and refined grains (all P < .05). The multiple-goal group reported significant reduction in percent energy from total, saturated, monounsaturated, and trans fat intake and significant increase in leisure time walking (all P < .05). CONCLUSION: A multiple-goal approach over 4 months can improve dietary and physical activity outcomes, while a single-goal approach may facilitate improvement in one behavioral domain. Additional research is needed to evaluate maintenance of the achieved changes.
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Enfermedades Cardiovasculares/prevención & control , Técnicas de Apoyo para la Decisión , Diabetes Mellitus Tipo 2/terapia , Dieta para Diabéticos/psicología , Ejercicio Físico/psicología , Adulto , Anciano , Biomarcadores , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/psicología , Femenino , Objetivos , Humanos , Masculino , Persona de Mediana Edad , Entrevista Motivacional , Obesidad/psicología , Sobrepeso/psicología , Proyectos Piloto , Factores de Riesgo , Estadísticas no Paramétricas , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To evaluate the impact of a worksite diabetes prevention intervention on secondary outcomes regarding the change in diet quality and components of the Health Action Process Approach (HAPA) theoretical framework. DESIGN: Pretest-posttest control group design with 3-month follow-up. SETTING: University worksite. PARTICIPANTS: Employees aged 18-65 years with prediabetes (n = 68). INTERVENTION: A 16-week group-based intervention adapted from the Diabetes Prevention Program. MAIN OUTCOME MEASURES: Diet quality was assessed using the Alternative Healthy Eating Index 2010; HAPA components were assessed via written questionnaire. ANALYSIS: Repeated-measures ANOVA compared the between- and within-group change in outcomes across time. RESULTS: Significant difference occurred between groups for the change in consumption of nuts/legumes and red/processed meats postintervention and for fruits at 3-month follow-up (all P < .05); a significant increase in total Alternative Healthy Eating Index 2010 score occurred postintervention in the experimental group (P = .002). The changes in action planning, action self-efficacy, and coping self-efficacy from HAPA were significantly different between groups after the intervention; the change in outcome expectancies was significantly different between groups at 3-month follow-up (all P < .05). CONCLUSIONS AND IMPLICATIONS: The worksite intervention facilitated improvement in diet quality and in planning and efficacious beliefs regarding diabetes prevention. Further research is needed to evaluate the long-term impact of the intervention.
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Diabetes Mellitus Tipo 2/prevención & control , Dieta/estadística & datos numéricos , Dieta/normas , Conductas Relacionadas con la Salud , Promoción de la Salud/estadística & datos numéricos , Lugar de Trabajo , Adulto , Femenino , Promoción de la Salud/métodos , Humanos , Masculino , Persona de Mediana Edad , Autoeficacia , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Working adults spend much time at the workplace, an ideal setting for wellness programs targeting weight loss and disease prevention. Few randomized trials have evaluated the efficacy of worksite diabetes prevention programs. This study evaluated the efficacy of a worksite lifestyle intervention on metabolic and behavioral risk factors compared with usual care. METHODS: A pretest-posttest control group design with 3-month follow-up was used. Participants with prediabetes were recruited from a university worksite and randomized to receive a 16-week lifestyle intervention (n = 35) or usual care (n = 34). Participants were evaluated at baseline, postintervention, and 3-month follow-up. Dietary intake was measured by a food frequency questionnaire and level of physical activity by accelerometers. Repeated measures analysis of variance compared the change in outcomes between and within groups. RESULTS: Mean (standard error [SE]) weight loss was greater in the intervention (-5.5% [0.6%]) than in the control (-0.4% [0.5%]) group (P < .001) postintervention and was sustained at 3-month follow-up (P < .001). Mean (SE) reductions in fasting glucose were greater in the intervention (-8.6 [1.6] mg/dL) than in the control (-3.7 [1.6] mg/dL) group (P = .02) postintervention; both groups had significant glucose reductions at 3-month follow-up (P < .001). In the intervention group, the intake of total energy and the percentage of energy from all fats, saturated fats, and trans fats decreased, and the intake of dietary fiber increased (all P < .01) postintervention. CONCLUSION: The worksite intervention improved metabolic and behavioral risk factors among employees with prediabetes. The long-term impact on diabetes prevention and program sustainability warrant further investigation.
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Diabetes Mellitus Tipo 2/prevención & control , Promoción de la Salud/métodos , Estilo de Vida , Estado Prediabético/diagnóstico , Pérdida de Peso , Lugar de Trabajo , Adulto , Conducta Alimentaria , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora , Ohio , Evaluación de Programas y Proyectos de Salud , Factores de Riesgo , UniversidadesRESUMEN
BACKGROUND: People with prediabetes are at increased risk for developing type 2 diabetes mellitus. Weight reduction through lifestyle modification can significantly reduce diabetes risk. Yet, weight loss varies among individuals and some people do not achieve clinically meaningful weight loss after treatment. OBJECTIVE: Our aim was to evaluate the time point and threshold for achieving ≥5% weight loss after completion of a 16-week worksite, lifestyle intervention for diabetes prevention. DESIGN: Weight change before and after the behavioral intervention among participants randomized to the experimental group was examined. PARTICIPANTS/SETTING: Individuals with prediabetes aged 18 to 65 years with a body mass index (calculated as kg/m(2)) of 25 to 50 at Ohio State University were eligible. INTERVENTION: The 16-week, group-based intervention, adapted from the Diabetes Prevention Program, was delivered to 32 participants in the experimental group. MAIN OUTCOME MEASURES: Percent weight loss was assessed weekly during the intervention and at 4- and 7-month follow-up. STATISTICAL ANALYSES PERFORMED: Linear regression modeled the relationship between percent weight loss during month 1 of the intervention and percent weight loss at 4 and 7 months. Logistic regression modeled failure to lose ≥5% weight loss at 4 and 7 months using weekly weight change during the first month of intervention. RESULTS: Percent weight loss at intervention week 5 was significantly associated with percent weight loss at 4 and 7 months (all P<0.001). Only 11.1% and 12.5% of participants who failed to achieve a 2.5% weight-loss threshold during month 1 achieved ≥5% weight loss at months 4 and 7, respectively. CONCLUSIONS: The first month of lifestyle treatment is a critical period for helping participants achieve weight loss. Otherwise, individuals who fail to achieve at least 2.5% weight loss may benefit from more intensive rescue efforts or stepped-care interventions.
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Terapia Conductista , Diabetes Mellitus Tipo 2/prevención & control , Estilo de Vida , Obesidad/terapia , Sobrepeso/terapia , Estado Prediabético/terapia , Psicoterapia de Grupo , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Terapia Combinada , Dieta Reductora , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora , Obesidad/sangre , Obesidad/complicaciones , Obesidad/dietoterapia , Ohio , Sobrepeso/sangre , Sobrepeso/complicaciones , Sobrepeso/dietoterapia , Cooperación del Paciente , Estado Prediabético/sangre , Estado Prediabético/complicaciones , Estado Prediabético/dietoterapia , Universidades , Pérdida de Peso , Lugar de Trabajo , Adulto JovenRESUMEN
OBJECTIVE: Few worksite trials have examined the impact of diabetes prevention interventions on psychological and behavioral outcomes. Thus, the impact of a worksite lifestyle intervention on psychosocial outcomes, food group intake, and step counts for physical activity (PA) was evaluated. METHOD: A randomized pretest/posttest control group design with 3-month follow-up was employed from October 2012 to May 2014 at a U.S. university worksite among employees with prediabetes. The experimental group (n=35) received a 16-week group-based intervention while the control group received usual care (n=33). Repeated measures analysis of variance compared the change in outcomes between groups across time. RESULTS: A significant difference occurred between groups post-intervention for self-efficacy associated with eating and PA; goal commitment and difficulty; satisfaction with weight loss and physical fitness; peer social support for healthful eating; generation of alternatives for problem solving; and intake of fruits, meat, fish, poultry, nuts, and seeds (all ps < .05). The experimental group significantly increased step counts post-intervention (p = .0279) and were significantly more likely to report completing their work at study end (p = .0231). CONCLUSION: The worksite trial facilitated improvement in modifiable psychosocial outcomes, dietary patterns, and step counts; the long-term impact on diabetes prevention warrants further investigation. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01682954.