Feasibility, effectiveness, and perceptions of an Internet-and incentive-based behavioral weight loss intervention for overweight and obese college freshmen: A mixed methods approach

Challenges inherent with the transition to college are often accompanied by weight gain among college freshmen. Weight gain and duration of obesity increase metabolic syndrome and cardiovascular disease risk in young adulthood, which supports the need for weight loss interventions tailored to college students. The purpose of this investigation was to conduct a mixed methods pilot trial to determine the efficacy and acceptability of a semester long Internet-and incentive-based weight loss intervention for overweight/obese college freshmen. Participants (n = 27, aged >18 yrs, BMI >25) were randomly assigned to a 12-week social cognitive theory (SCT)-based intervention (Fit Freshmen [FF]) or a health information control group. The FF intervention also included modest financial incentives for weight loss. Primary outcomes included body weight/composition, dietary and physical activity (PA) behaviors, and psychosocial measures (i.e. self-efficacy, self-regulation) associated with diet, PA, and weight loss. Students in the FF intervention participated in focus groups to provide qualitative feedback on program structure and design. FF participants demonstrated significant reductions (all group differences

Mixed methods evaluation of a randomized control pilot trial targeting sugar-sweetened beverage behaviors

This Excessive sugar-sweetened beverage (SSB) consumption and low health literacy skills have emerged as two public health concerns in the United States (US);however, there is limited research on how to effectively address these issues among adults. As guided by health literacy concepts and the Theory of Planned Behavior (TPB), this randomized controlled pilot trial applied the RE-AIM framework and a mixed methods approach to examine a sugar-sweetened beverage (SSB) intervention (SipSmartER), as compared to a matched-contact control intervention targeting physical activity (Move-More). Both 5-week interventions included two interactive group sessions and three support telephone calls. Executing a patient-centered developmental process, the primary aim of this paper was to evaluate patient feedback on intervention content and structure. The secondary aim was to understand the potential reach (i.e., proportion enrolled, representativeness) and effectiveness (i.e. health behaviors, theorized mediating variables, quality of life) of SipS- martER. Twenty-five participants were randomized to SipSmartER (n = 14) or MoveMore (n = 11). Participants’ intervention feedback was positive, ranging from 4.2 - 5.0 on a 5-point scale. Qualitative assessments reavealed several opportuneties to improve clarity of learning materials, enhance instructions and communication, and refine research protocols. Although SSB consumption decreased more among the SipS-martER participants (?256.9 ± 622.6 kcals), there were no significant group differences when compared to control participants (?199.7 ± 404.6 kcals). Across both groups, there were significant improvements for SSB attitudes, SSB behavioral intentions, and two media literacy constructs. The value of using a patient-centered approach in the developmental phases of this intervention was apparent, and pilot findings suggest decreased SSB may be achieved through targeted health literacy and TPB strategies. Future efforts are needed to examine the potential public health impact of a large-scale trial to address health literacy and reduce SSB.

Predictors of Successful Weight Loss Maintenance: A Qualitative Comparative Analysis

Individuals successful at weight loss maintenance (WTLM) utilize similar behaviors but in varying amounts and combinations. Research identifying characteristics which predict WTLM success could be used to develop effective WTLM treatment programs. The purpose of this retrospective analysis was to determine behavioral (e.g., self monitoring of dietary intake) and biological factors (e.g., sex) which may influence WTLM success. Methods: In a previously conducted 12-month WTLM study, weight-reduced middle-aged and older men and women (n = 39) were assigned behavioral goals and asked to daily self-monitor body weight, fruit and vegetable intake, water consumption, and physical activity. This investigation utilized a crisp set qualitative comparative analysis (QCA) to characterize individuals’ weight changes and behaviors. Sex difference in clinically significant weight loss (WL) (≥5% WL) at 12 months was investigated, and growth curve models estimated interaction effects between sex and WTLM predictors. Results: QCA findings suggest patterns of weight change during the initial three months of WTLM treatment may dictate 12-month weight outcomes. No sex difference was found in clinically significant WL or in the interaction of sex and behaviors on weight change. Conclusions: WTLM treatments should provide more intensive support during transition from WL to WTLM, particularly during the first three months.

Is increased water consumption among older adults associated with improvements in glucose homeostasis?

Obesity and impaired glucose homeostasis in older adults place these individuals at risk for diabetes. Dehydration, glucose homeostasis, and insulin resistance are related;while aging and dehydration are associated with decreased glucose tolerance, weight loss can improve glycemia. For older adults following hypocaloric diets, additional water consumption may lead to greater weight loss. Further more, research suggests an association between insulin resistance and the body water retention hormone, arginine vasopressin (AVP). Analysis of the association between plasma copeptin (an AVP derivative) and fasting glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) may provide further insight into the relationship between dehydration and diabetes risk. Our objective was to investigate the possibility that increased water consumption among older adults (n = 29, BMI = 31 ± 1 kg/m2, age = 62 ± 1 years) could improve glucose homeostasis beyond that observed with weight loss, as well as associations between plasma copeptin and diabetes risk. This retrospective analysis utilized data from a previous investigation, in which obese/overweight older adults were assigned to one of two groups: 1) Water: consume 500 ml of water prior to three daily meals over a 12-week hypocaloric diet intervention, or 2) Non-water: hypocaloric diet alone. In the present analysis, fasting plasma glucose and insulin, HOMA-IR, and plasma copeptin were evaluated, and compared to urinary specific gravity (USG), drinking water consumption, and body weight. Analyses performed using group assignment, volume of drinking water consumed or among a subgroup pair-matched for weight loss and sex did not reveal significant differences between groups. However in the full sample, plasma insulin concentration was associated with USG (r = 0.512,

Kaempferol improves glucose uptake in skeletal muscle via an AMPK-dependent mechanism

Insulin resistance is a hallmark of type-2 diabetes(T2D)pathogenesis.Because skeletal muscle(SkM)is the major tissue for insulin-mediated glucose disposal,insulin resistance in SkM is considered a major risk factor for developing T2D.Thus,the identifi cation of compounds that enhance the ability of SkM to take up glucose is a promising strategy for preventing T2D.Our previous work showed that kaempferol,a fl avonol present in many foods,improves insulin sensitivity in obese mice,however,the mechanism underlying this beneficial action remains unclear.Here,we show that kaempferol directly stimulates glucose uptake and prevents lipotoxicity-impaired glucose uptake in primary human SkM.Kaempferol stimulates Akt phosphorylation in a time-dependent manner in human SkM cells.The effect of kaempferol on glucose uptake was blunted by inhibition of glucose transporter 4,phosphoinositide 3-kinase(PI3K),or AMPK.In addition,kaempferol induced AMPK phosphorylation,and inhibition of AMPK prevented kaempferol-stimulated Akt phosphorylation.In vivo,kaempferol administration induced rapid glucose disposal accompanied with increased Akt and AMPK phosphorylation in SkM tissue of the mice.Taken together,these fi ndings suggest that kaempferol stimulates glucose uptake in SkM via an AMPK/Akt dependent mechanism,and it may be a viable therapeutic agent for insulin resistance.