Innovative approaches to weight loss in a high-risk population: The small changes and lasting effects (SCALE) trial

Erica G Phillips, Martin T Wells, Ginger Winston, Rosio Ramos, Carol M Devine, Elaine Wethington, Janey C Peterson, Brian Wansink, Mary Charlson, Erica G Phillips, Martin T Wells, Ginger Winston, Rosio Ramos, Carol M Devine, Elaine Wethington, Janey C Peterson, Brian Wansink, Mary Charlson

Abstract

Objective: To evaluate the efficacy of a small change behavioral weight loss intervention with or without a positive affect/self-affirmation (PA/SA) component on weight loss at 12 months.

Methods: Black and Hispanic adults (N = 405) with body mass index 25-50 kg/m2 selected one of ten small change eating strategies and a physical activity goal, randomly with/without PA/SA. Participants were followed by community health workers at set intervals (weekly in months 1-3; biweekly in months 4-9; once monthly in months 10-12).

Results: There was no difference in weight loss at 12 months between participants in the small change approach alone (1.1%) versus the small change PA/SA intervention (1.2%). During treatment, 9% of participants lost at least 7% of their initial body weight. Participants who reported more interval life events had a lower likelihood of losing weight (P < 0.0001). However, those randomized to the small change PA/SA intervention gained less weight (+0.3% vs. 2.3% gain; P < 0.0001).

Conclusions: The small change PA/SA intervention did not lead to a significant difference in weight loss in comparison to the small change approach alone. It did, however, decrease the negative impact of psychosocial stressors on weight gain among participants with more interval life events.

Trial registration: ClinicalTrials.gov NCT01198990.

© 2017 The Obesity Society.

Figures

Figure 1. SCALE CONSORT Flow Diagram
Figure 1. SCALE CONSORT Flow Diagram
Figure 2. Impact of Interval Life Events…
Figure 2. Impact of Interval Life Events - Family Conflicts on Weight Loss
Figure 3. Path Model for the Effects…
Figure 3. Path Model for the Effects of the Positive-Affect Self-Affirmation Intervention
Direct effect t-statistics for the endogenous variables (percent of weight loss, adherence to eating behavior, adherence to physical behavior, efficacy for activity and eating behavior, assessment of challenge for eating behavior, and assessment of challenge for physical activity behavior) and some key exogenous variables (ILE-Family, ILE-Other, and PA/SA). The significance notations (*, **, #) within the rectangles containing the endogenous variables denote the significance of the PA/SA intervention. For the age gender and SNAP t-statistics and significance results see Table 3. Controls for site and community health worker using Huber-White standard errors. N=248 and the significance are denoted by #p<.1. * p<.05, **p<.01. ILE-Family = Interval Life Events –Family Conflicts ILE-Other = Interval Life Events – Other PA/SA = Positive Affect/ Self-Affirmation Intervention SNAP = Supplemental Nutrition Assistance Program

References

    1. Kumanyika SK. Special issues regarding obesity in minority populations. Ann Intern Med. 1993;119:650–654.
    1. Wing RR, Lang W, Wadden TA, Safford M, Knowler WC, Bertoni AG, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34:1481–1486.
    1. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.
    1. Stevens VJ, Obarzanek E, Cook NR, Lee IM, Appel LJ, Smith West D, et al. Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann Intern Med. 2001;134:1–11.
    1. Kumanyika SK, Obarzanek E, Stevens VJ, Hebert PR, Whelton PK. Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials. Am J Clin Nutr. 1991;53:1631S–1638S.
    1. Hill JO. Can a small-changes approach help address the obesity epidemic? A report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council. Am J Clin Nutr. 2009;89:477–484.
    1. Damschroder LJ, Lutes LD, Kirsh S, Kim HM, Gillon L, Holleman RG, et al. Small-changes obesity treatment among veterans: 12-month outcomes. Am J Prev Med. 2014;47:541–553.
    1. Cummings DM, Lutes LD, Littlewood K, DiNatale E, Hambidge B, Schulman K. EMPOWER: A randomized trial using community health workers to deliver a lifestyle intervention program in African American women with Type 2 diabetes: Design, rationale, and baseline characteristics. Contemporary Clinical Trials. 2013;36:147.
    1. Lutes LD, Dinatale E, Goodrich DE, Ronis DL, Gillon L, Kirsh S, et al. A randomized trial of a small changes approach for weight loss in veterans: design, rationale, and baseline characteristics of the ASPIRE-VA trial. Contemp Clin Trials. 2013;34:161–172.
    1. Lutes LD, Daiss SR, Barger SD, Read M, Steinbaugh E, Winett RA. Small changes approach promotes initial and continued weight loss with a phone-based follow-up: nine-month outcomes from ASPIRES II. Am J Health Promot. 2012;26:235–238.
    1. Damschroder LJ, Lutes LD, Goodrich DE, Gillon L, Lowery JC. A small-change approach delivered via telephone promotes weight loss in veterans: results from the ASPIRE-VA pilot study. Patient Educ Couns. 2010;79:262–266.
    1. Lutes LD, Winett RA, Barger SD, Wojcik JR, Herbert WG, Nickols-Richardson SM, et al. Small changes in nutrition and physical activity promote weight loss and maintenance: 3-month evidence from the ASPIRE randomized trial. Ann Behav Med. 2008;35:351–357.
    1. Zinn C, Schofield GM, Hopkins WG. Efficacy of a “small-changes” workplace weight loss initiative on weight and productivity outcomes. J Occup Environ Med. 2012;54:1224–1229.
    1. Zinn C, Schofield GM, Hopkins WG. A “small-changes” workplace weight loss and maintenance program: examination of weight and health outcomes. J Occup Environ Med. 2012;54:1230–1238.
    1. Rodearmel SJ, Wyatt HR, Stroebele N, Smith SM, Ogden LG, Hill JO. Small changes in dietary sugar and physical activity as an approach to preventing excessive weight gain: the America on the Move family study. Pediatrics. 2007;120:e869–79.
    1. Rodearmel SJ, Wyatt HR, Barry MJ, Dong F, Pan D, Israel RG, et al. A family-based approach to preventing excessive weight gain. Obesity (Silver Spring) 2006;14:1392–1401.
    1. Charlson ME, Wells MT, Peterson JC, Boutin-Foster C, Ogedegbe GO, Mancuso CA, et al. Mediators and moderators of behavior change in patients with chronic cardiopulmonary disease: the impact of positive affect and self-affirmation. Transl Behav Med. 2014;4:7–17.
    1. Phillips-Caesar EG, Winston G, Peterson JC, Wansink B, Devine CM, Kanna B, et al. Small Changes and Lasting Effects (SCALE) Trial: The Formation of a Weight Loss Behavioral Intervention Using EVOLVE. Contemp Clin Trials. 2015;41C:118–128.
    1. Wansink B. From mindless eating to mindlessly eating better. Physiol Behav. 2010;100:454–463.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.
    1. Anonymous Behavioral Risk Factor Surveillance System Survey Questionnaire. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2012.
    1. van Strien T, Frijters JER, Bergers GPA, Defares PB. The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord. 1986;5:295–315.
    1. Devine CM, Jastran M, Jabs J, Wethington E, Farell TJ, Bisogni CA. “A lot of sacrifices:” work-family spillover and the food choice coping strategies of low-wage employed parents. Soc Sci Med. 2006;63:2591–2603.
    1. Wansink B, Hanks AS, Kaipainen K. Slim by Design: Kitchen Counter Correlates of Obesity. Health Educ Behav. 2015
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–396.
    1. Spielberger CD, Gorsuch RL, Lushene R. Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press; Palo Alto, CA: 1970.
    1. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32:705–714.
    1. Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res. 1967;11:213–218.
    1. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41:1284–1292.
    1. Bentler PM, Raykov T. On measures of explained variance in nonrecursive structural equation models. J Appl Psychol. 2000;85:125–131.
    1. Bentler P, Freeman E. Tests for stability in linear structural equation systems. Psychometrika. 1983;48:143.
    1. West DS, Elaine Prewitt T, Bursac Z, Felix HC. Weight loss of black, white, and Hispanic men and women in the Diabetes Prevention Program. Obesity (Silver Spring) 2008;16:1413–1420.
    1. Bennett GG, Warner ET, Glasgow RE, Askew S, Goldman J, Ritzwoller DP, et al. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Arch Intern Med. 2012;172:565–574.
    1. Ockene IS, Tellez TL, Rosal MC, Reed GW, Mordes J, Merriam PA, et al. Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino Diabetes Prevention Project. Am J Public Health. 2012;102:336–342.
    1. Pressman SD, Cohen S. Does positive affect influence health? Psychol Bull. 2005;131:925–971.
    1. Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes (Lond) 2013;37:889–891.
    1. Grossi E, Dalle Grave R, Mannucci E, Molinari E, Compare A, Cuzzolaro M, et al. Complexity of attrition in the treatment of obesity: clues from a structured telephone interview. Int J Obes (Lond) 2006;30:1132–1137.
    1. Nackers LM, Ross KM, Perri MG. The association between rate of initial weight loss and long-term success in obesity treatment: does slow and steady win the race? Int J Behav Med. 2010;17:161–167.
    1. Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc. 2011;111:92–102.
    1. Viswanathan M, Kraschnewski JL, Nishikawa B, Morgan LC, Honeycutt AA, Thieda P, et al. Outcomes and costs of community health worker interventions: a systematic review. Med Care. 2010;48:792–808.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever