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The roles of the dietitian in an 18-week telephone and mobile application nutrition intervention for upper gastrointestinal cancer: a qualitative analysis.
Testa, S, Furness, K, Choi, T, Haines, T, Huggins, CE
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2023;31(4):245
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Patients with upper gastrointestinal (UGI) cancer (oesophagus, gastric, and pancreas) are vulnerable to malnutrition. Symptoms of the cancer and its treatment are barriers to usual eating patterns that contribute to unintentional weight loss. The aim of this study was to explore the patient-dietitian experience of an 18-week nutrition intervention (the TEND study) delivered using the telephone and a mobile application to people newly diagnosed with UGI cancer to elucidate the roles of the dietitian. This study was an analysis set within the TEND study (a three-arm randomised controlled trial exploring the impact of delivering an 18-week intensive nutrition intervention to patients newly diagnosed with UGI cancer). Participants were allocated to receive the intervention using either the telephone or a mobile application, myPace. Results showed that: - rapport can be built within the patient-dietitian relationship without face-to-face communication. - the roles of the dietitian were characterised by regular collaborative problem-solving to encourage empowerment, a reassuring care navigator (including anticipatory guidance), and rapport building via reliable psychosocial support. - that role limitations led to unmet needs as the dietitian was constrained by poorly managed cancer symptoms that negatively impacted oral intake and subsequently weight stability. Authors concluded that more research is needed to examine an advanced care role for dietitians in the management of nutrition impact symptoms.
Abstract
PURPOSE This study aimed to explore the patient-dietitian experience during an 18-week nutrition counselling intervention delivered using the telephone and a mobile application to people newly diagnosed with upper gastrointestinal (UGI) cancer to (1) elucidate the roles of the dietitian during intervention delivery and (2) explore unmet needs impacting nutritional intake. METHODS Qualitative case study methodology was followed, whereby the case was the 18-week nutrition counselling intervention. Dietary counselling conversations and post-intervention interviews were inductively coded from six case participants which included fifty-one telephone conversations (17 h), 244 written messages, and four interviews. Data were coded inductively, and themes constructed. The coding framework was subsequently applied to all post-study interviews (n = 20) to explore unmet needs. RESULTS Themes describing the roles of the dietitian were as follows: regular collaborative problem-solving to encourage empowerment, a reassuring care navigator including anticipatory guidance, and rapport building via psychosocial support. Psychosocial support included provision of empathy, reliable care provision, and delivery of positive perspective. Despite intensive counselling from the dietitian, nutrition impact symptom management was a core unmet need as it required intervention beyond the scope of practice for the dietitian. CONCLUSION Delivery of nutrition care via the telephone or an asynchronous mobile application to people with newly diagnosed UGI cancer required the dietitian to adopt a range of roles to influence nutritional intake: they empower people, act as care navigators, and provide psychosocial support. Limitations in dietitians' scope of practice identified unmet patient's needs in nutrition impact symptom management, which requires medication management. TRIAL REGISTRATION 27th January 2017 Australian and New Zealand Clinical Trial Registry (ACTRN12617000152325).
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Human milk miRNAs associate to maternal dietary nutrients, milk microbiota, infant gut microbiota and growth.
Yeruva, L, Mulakala, BK, Rajasundaram, D, Gonzalez, S, Cabrera-Rubio, R, Martínez-Costa, C, Collado, MC
Clinical nutrition (Edinburgh, Scotland). 2023;42(12):2528-2539
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Human milk is a source of nutrition during the early stages of development. Human milk contains nutritive and non-nutritive bioactives such as microRNAs (miRNAs or miRs). These bioactives likely program an infant's growth, development, and physiological systems (i.e., immune system, brain, liver). The aim of this study was to examine the potential impact of maternal diet on human milk miRNAs profile and the link to microbiota. This study was an observational study which included a subset of 60 healthy lactating women (n = 30 milk samples in each cluster). Results showed that that: - human milk miRNA's profile was altered based on maternal dietary protein source (plant or animal protein). - miRNA features were distinct based on maternal diet intake and correlated with dietary plant polyphenols, and milk microbiota. - milk miRNAs, irrespective of maternal dietary source, have a strong correlation with infant gut microbiota early in life as well as to infant anthropometric measures. Authors concluded that their findings extend current knowledge that milk miRNAs are differentially expressed based on maternal protein source, associate with specific set of milk microbiota and maternal intake of polyphenols, and infant microbiota for optimal growth and development.
Abstract
BACKGROUND Maternal diet influences the milk composition, yet little information is available on the impact of maternal diet on milk miRNAs expression. Further, the association of human milk miRNAs to maternal diet and milk microbiota is not explored. In addition, the role of milk miRNAs on the infant gut microbiota, infant growth and development has not been investigated. METHODS Milk samples were collected from 60 healthy lactating women at ≤15d post-partum, HTG transcriptome assay was performed to examine milk miRNA profile. Maternal clinical and dietary clusters information were available and infant anthropometric measures were followed up to one year of age. Milk and infant microbiota were analyzed by 16S rRNA gene sequencing and integrative multi-omics data analysis was performed to identify potential association between microRNA, maternal dietary nutrients and microbiota. RESULTS Discriminant analysis revealed that the milk miRNAs were clustered into groups according to the maternal protein source. Interestingly, 31 miRNAs were differentially expressed (P adj < 0.05) between maternal dietary clusters (Cluster 1: enriched in plant protein and fibers and Cluster 2: enriched in animal protein), with 30 miRNAs downregulated in the plant protein group relative to animal protein group. Pathway analysis revealed that the top enriched pathways (P adj < 0.01) were involved in cell growth and proliferation processes. Furthermore, significant features contributing to the clustering were associated with maternal dietary nutrients and milk microbiota (r > 0.70). Further, miR-378 and 320 family miRNAs involved in adipogenesis were positively correlated to the infant BMI-z-scores, weight, and weight for length-z-scores at 6 months of age. CONCLUSIONS Maternal dietary source impacts the milk miRNA expression profile. Further, miRNAs were associated with maternal dietary nutrients, milk microbiota and to the infant gut microbiota and infant growth and development. CLINICAL TRIAL The study is registered in ClinicalTrials.gov. The identification number is NCT03552939.
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Lifestyle risk behaviours among adolescents: a two-year longitudinal study of the impact of the COVID-19 pandemic.
Gardner, LA, Debenham, J, Newton, NC, Chapman, C, Wylie, FE, Osman, B, Teesson, M, Champion, KE
BMJ open. 2022;12(6):e060309
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The global spread of COVID-19 and subsequent lockdown measures have presented challenges worldwide. Previous research has highlighted the importance of six key lifestyle behaviours, including diet, physical activity, sleep, sedentary behaviour (including recreational screen time), alcohol use and smoking—collectively referred to as the ‘Big 6’—for the short-term and long-term health of adolescents. The aim of this study was to examine changes in the prevalence of six key chronic disease risk factors from before to during the COVID-19 pandemic, and also to explore whether differences over time are associated with gender and lockdown status. This study is a prospective cohort study among a large and geographically diverse sample of adolescents. The sample included 983 students (girls = 54.8%) from 22 schools. Results show that: - over the 2-year period, the prevalence of excessive recreational screen time, insufficient fruit intake and alcohol and tobacco use increased. - alcohol use increased more among girls compared to boys. - the prevalence of insufficient sleep reduced in the overall sample; yet, increased among girls. - being in lockdown was associated with improvements in sugar-sweetened beverages consumption and discretionary food intake. Authors conclude that supporting young people to improve or maintain their health behaviours, regardless of the course of the pandemic, is important, alongside targeted research and intervention efforts to support groups that may be disproportionately impacted, such as adolescent girls.
Abstract
OBJECTIVE To examine changes in the prevalence of six key chronic disease risk factors (the "Big 6"), from before (2019) to during (2021) the COVID-19 pandemic, among a large and geographically diverse sample of adolescents, and whether differences over time are associated with lockdown status and gender. DESIGN Prospective cohort study. SETTING Three Australian states (New South Wales, Queensland and Western Australia) spanning over 3000 km. PARTICIPANTS 983 adolescents (baseline Mage=12.6, SD=0.5, 54.8% girl) drawn from the control group of the Health4Life Study. PRIMARY OUTCOMES The prevalence of physical inactivity, poor diet (insufficient fruit and vegetable intake, high sugar-sweetened beverage intake, high discretionary food intake), poor sleep, excessive recreational screen time, alcohol use and tobacco use. RESULTS The prevalence of excessive recreational screen time (prevalence ratios (PR)=1.06, 95% CI=1.03 to 1.11), insufficient fruit intake (PR=1.50, 95% CI=1.26 to 1.79), and alcohol (PR=4.34, 95% CI=2.82 to 6.67) and tobacco use (PR=4.05 95% CI=1.86 to 8.84) increased over the 2-year period, with alcohol use increasing more among girls (PR=2.34, 95% CI=1.19 to 4.62). The prevalence of insufficient sleep declined across the full sample (PR=0.74, 95% CI=0.68 to 0.81); however, increased among girls (PR=1.24, 95% CI=1.10 to 1.41). The prevalence of high sugar-sweetened beverage (PR=0.61, 95% CI=0.64 to 0.83) and discretionary food consumption (PR=0.73, 95% CI=0.64 to 0.83) reduced among those subjected to stay-at-home orders, compared with those not in lockdown. CONCLUSION Lifestyle risk behaviours, particularly excessive recreational screen time, poor diet, physical inactivity and poor sleep, are prevalent among adolescents. Young people must be supported to find ways to improve or maintain their health, regardless of the course of the pandemic. Targeted approaches to support groups that may be disproportionately impacted, such as adolescent girls, are needed. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12619000431123).
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Longitudinal Weight Gain and Related Risk Behaviors during the COVID-19 Pandemic in Adults in the US.
Bhutani, S, vanDellen, MR, Cooper, JA
Nutrients. 2021;13(2)
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The Covid-19 pandemic has altered health behaviours of many individuals resulting in weight gain. This cross-sectional study of 1779 individuals aimed to determine the long-term impact of Covid-19 on health behaviours and weight gain over 5 months. The results showed that most participants (40%) body weight increased alongside increased processed food intake and snacking. 33% of the individuals who gained weight continued to gain weight and 28% maintained their higher weight after lockdown measures were lifted. Take-away meals, processed food intake and stress levels remained high post-lockdown in those who gained weight. It was concluded that lockdown measures may have impacted daily life resulting in weight gain which may perpetuate long-term. This study could be used by healthcare professionals to understand that lockdown measures may have altered eating behaviours resulting in weight gain and that these may need to be uncovered to aid long-term weight loss.
Abstract
Cross-sectional analyses have shown increased obesogenic behaviors and a potential for weight gain during COVID-19 related peak-lockdown (March-May 2020), but longitudinal data are lacking. This study assessed longitudinal changes in body weight and lifestyle behaviors in the US adults during the pandemic. METHODS We used Qualtrics survey to collect self-reported data on body weight, dietary, physical activity, and psychological variables (n = 727) during the peak-lockdown (April/May) and at post-lockdown (September/October). Peak-lockdown weight data were categorized based on the magnitude of weight gained, maintained, or lost, and behavioral differences were examined between categories at two time points. RESULTS Body weight increased (+0.62 kg; p < 0.05) at the post-lockdown period. The body mass index also increased (26.38 ± 5.98 kg/m2 vs. 26.12 ± 5.81 kg/m2; p < 0.01) at the post-lockdown period vs. peak-lockdown period. Close to 40% of participants reported gaining either 1-4 lbs or >5 lbs of body weight during the peak-lockdown, while 18.2% lost weight. Weight-gainers engaged in riskier dietary behaviors such as frequent ultra-processed food intake (p < 0.01) and snacking (p < 0.001), were less active, and reported high stress and less craving control during peak-lockdown. Of those gaining >5 lbs, 33% continued to gain weight after the lockdown eased, while 28% maintain higher body weight. In weight-gainers, takeout meal frequency increased, and high ultra-processed food intake and stress, and low craving control continued to persist after the lockdown eased. CONCLUSION We show that the COVID-19 lockdown periods disrupted weight management among many Americans and that associated health effects are likely to persist.
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Oral administration of Lactobacillus crispatus M247 to papillomavirus-infected women: results of a preliminary, uncontrolled, open trial.
DI Pierro, F, Criscuolo, AA, Dei Giudici, A, Senatori, R, Sesti, F, Ciotti, M, Piccione, E
Minerva obstetrics and gynecology. 2021;73(5):621-631
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Vaginal microbiotas are clustered into five different possible categories, according to their bacterial dominance. The aim of this study was to evaluate a possible correlation between the vaginal microbiota and the 90-day persistence of Human Papilloma Virus (HPV) infection - both high-risk (HR) and low-risk (LR) strains - in the cervical-vaginal area. The study is an observational, open, pilot study. Participants included a group of 35 women with HPV cervical infection, with normal or abnormal cervical cytology, and recurrent vaginal infections. Results show that after 90 days of treatment with L. crispatus M247, 97% of women had a vaginal microbiota that was Lactobacillus-dominated. Furthermore, after 90 days, 71% of women were HPV-negative, with respect to both HR and LR strains, and 29% were still infected by HR-HPV strains. Authors conclude that their findings are preliminary and uncontrolled, thus further investigation with a higher number of women with HPV infection would help to verify the long-term effect of L. crispatus M247.
Abstract
BACKGROUND Vaginal microbiotas can be clustered into five different possible categories (CST I to V), according to their bacterial dominance. In CST I, the dominance of Lactobacillus crispatus seems to correlate with better vaginal health and with a lower incidence of sine causa infertility, preterm delivery, bacterial vaginosis, and viral (including human papillomavirus; HPV) infection. According to the same method of classifying the vaginal microbiome, CST IV (non-Lactobacillus-dominated) demonstrates a higher incidence of disorders. METHODS In an open, non-controlled study, we enrolled 35 HPV-positive women who mostly (N.=24) demonstrated CST IV status, with the other individuals categorized as having either CST III (N.=10) or CST II (N.=1) microbiotas. RESULTS After 90 days of oral treatment with a probiotic (L. crispatus M247) we observed a reduction of approximately 70% in HPV positivity and a significant change in CST status with 94% of women now classified as CST I. CONCLUSIONS Despite the limitations of our study, it is the first demonstration that it is possible to intervene orally with an L. crispatus probiotic to bring about a change in CST status and, in parallel, increased HPV clearance.
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The Dose-Effects of Caffeine on Lower Body Maximal Strength, Muscular Endurance, and Rating of Perceived Exertion in Strength-Trained Females.
Jones, L, Johnstone, I, Day, C, Le Marquer, S, Hulton, AT
Nutrients. 2021;13(10)
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Caffeine is a common ingredient in tea, coffee, chocolate, soft drinks and multi-ingredient pre-workout supplements. It is believed to elicit an ergogenic effect that enhances athletic performance. However, only very few studies have examined the effect of caffeine on women who take contraceptive pills. The aim of this double-blind, randomised, counterbalanced, crossover trial was to investigate the ergogenic effect of pre-exercise caffeine supplementation on strength performance and muscular endurance in strength-trained females taking contraceptives. Fourteen women were randomised to consume doses of 3 and 6 mg·kg−1 body mass of caffeine supplement or placebo thirty minutes prior to the exercise. Caffeine supplementation at 3 and 6 mg·kg−1 body mass significantly improved muscular endurance and total strength. No significant difference was observed between the higher and lower doses of caffeine in improving performance, indicating that the lower dose can potentially provide the same benefit without the adverse effect of the higher dose. The low dose had a similar caffeine content to that of a large coffee latte from a coffee shop, suggesting beneficial effects could be achieved through coffee/latte consumption. Caution should be applied when extrapolating the findings for eumenorrheic females with different training statuses. Healthcare practitioners can, however, use the results of this study to understand the potential benefits of caffeine for strength-trained women using hormone contraception.
Abstract
Caffeine supplementation has shown to be an effective ergogenic aid enhancing athletic performance, although limited research within female populations exists. Therefore, the aim of the investigation was to assess the effect of pre-exercise caffeine supplementation on strength performance and muscular endurance in strength-trained females. In a double-blind, randomised, counterbalanced design, fourteen strength-trained females using hormonal contraception consumed either 3 or 6 mg·kg-1 BM of caffeine or placebo (PLA). Following supplementation, participants performed a one-repetition maximum (1RM) leg press and repetitions to failure (RF) at 60% of their 1RM. During the RF test, rating of perceived exertion (RPE) was recorded every five repetitions and total volume (TV) lifted was calculated. Repeated measures ANOVA revealed that RF (p = 0.010) and TV (p = 0.012) attained significance, with pairwise comparisons indicating a significant difference between 3 mg·kg-1 BM and placebo for RF (p = 0.014), with an effect size of 0.56, and for 6 mg·kg-1 BM (p = 0.036) compared to the placebo, with an effect size of 0.65. No further significance was observed for 1RM or for RPE, and no difference was observed between caffeine trials. Although no impact on lower body muscular strength was observed, doses of 3 and 6 mg·kg-1 BM of caffeine improved lower body muscular endurance in resistance-trained females, which may have a practical application for enhancing resistance training stimuli and improving competitive performance.
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Pilot trial of a group cognitive behavioural therapy program for comorbid depression and obesity.
Lores, T, Musker, M, Collins, K, Burke, A, Perry, SW, Wong, ML, Licinio, J
BMC psychology. 2020;8(1):34
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Depression and obesity are significant global health concerns. Depression can significantly impact physical health and reduced immune function. The aim of this study was to examine the potential benefits of a novel group psychological intervention program. The study is a preliminary quasi-experimental (single-arm) before-after pilot trial of a newly developed group-based psychological intervention program for people with depression and comorbid obesity. The program consisted of 10 two-hour group sessions held weekly. A total of 24 participants were recruited to the program across two pilot groups. Results indicate that there was a significant reduction in participants’ depression and anxiety scores by program-end. Some evidence also shows improvements in weight-related negative cognitions. Authors conclude that the group therapy program therefore has considerable potential to be effective in helping people enjoy better mental health and improve health outcomes.
Abstract
BACKGROUND Depression and obesity are significant global health concerns that commonly occur together. An integrated group cognitive behavioural therapy program was therefore developed to simultaneously address comorbid depression and obesity. METHODS Twenty-four participants (63% women, mean age 46 years) who screened positively for depression with a body mass index ≥25 were recruited from a self-referred general population sample. The group therapy program (10 two-hour weekly sessions) was examined in a single-arm, before-after pilot trial, conducted in a behavioural health clinic in Adelaide, Australia. Primary outcomes included survey and assessment-based analyses of depression, anxiety, body image, self-esteem, and weight (kg), assessed at four time-points: baseline, post-intervention, three-months and 12-months post program. Eighteen participants (75%) completed the program and all assessments. RESULTS Significant improvements in depression, anxiety, self-esteem and body shape concern scores, several quality of life domains, eating behaviours and total physical activity (among others) - but not weight - were observed over the course of the trial. CONCLUSIONS Results from this pilot trial suggest that combining interventions for depression and obesity may be useful. Further development of the program, particularly regarding the potential for physical health benefits, and a randomised controlled trial, are warranted. TRIAL REGISTRATION Trial registration: ANZCTR, ACTRN12617001079336, 13 July 2017. Retrospectively registered after date of the first consent (6 July 2017), but before the date of the first intervention session (20 July 2017).
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Body Composition Changes Following a Very-Low-Calorie Pre-Operative Diet in Patients Undergoing Bariatric Surgery.
Sivakumar, J, Chong, L, Ward, S, Sutherland, TR, Read, M, Hii, MW
Obesity surgery. 2020;30(1):119-126
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Surgery for the treatment of morbid obesity has become a very common intervention due to the increased prevalence of disease and relative ineffective comparative therapies. The aim of this study was to evaluate overall changes in body composition in bariatric surgery patients undergoing a very-low-calorie-diet (VLCD). The study is a prospective analysis on patients who underwent a 2-week period of VLCD prior to bariatric surgery. A total of 60 patients were enrolled. This study demonstrated that although VLCD appears to induce considerable weight loss in a short period of time, the majority of this is attributable to lean body mass (62.2%) rather than fat mass (37.6%). Another notable finding is that greater losses in weight occur largely at the expense of lean body mass rather than fat mass. Authors conclude that a 2-week VLCD is an effective tool for pre-operative weight reduction. However, a large amount of the total weight loss is attributed to a loss of lean body mass.
Abstract
BACKGROUND Fatty liver in obese patients increases the technical difficulty of bariatric surgery. Pre-operative weight loss with a very-low-calorie diet (VLCD) is commonly used to facilitate surgery. Few studies have quantified the systemic effect of rapid pre-operative weight loss on body composition. The objective of this study is to evaluate body composition changes in bariatric surgery patients undergoing a VLCD. METHODS Body composition assessments were performed between August 2017 and January 2019 using dual-energy X-ray absorptiometry immediately before and after a 2-week VLCD at St Vincent's Hospital Melbourne. Data collected prospectively pre- and post-VLCD included total body weight, excess body weight, body mass index (BMI), lean body mass (LBM), fat mass (FM) and bone mineral content (BMC). The pre- and post-operative results were compared. RESULTS Forty-four patients completed both the 2-week VLCD and body composition assessments. Following a 2-week VLCD, patients lost a mean of 4.5 kg (range - 0.3 to 9.5) in a total body weight and 8.8% (range - 0.9 to 17.1) of excess body weight, with a mean reduction in body mass index of 1.6 kg/m2 (range - 0.2 to 3.1). Loss of LBM was 2.8 kg and was significantly greater than loss of FM, 1.7 kg (p < 0.05). BMC changes were insignificant. CONCLUSION A VLCD is an effective tool for pre-operative weight reduction. In this cohort, a large amount of the total weight loss was attributed to a loss of lean body mass. The impact of significant lean body mass loss and its relationship to short- and long-term health outcomes warrants further assessment.
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An exercise-based educational and motivational intervention after surgery can improve behaviors, physical fitness and quality of life in bariatric patients.
Gallé, F, Marte, G, Cirella, A, Di Dio, M, Miele, A, Ricchiuti, R, Liguori, F, Maida, P, Liguori, G
PloS one. 2020;15(10):e0241336
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Bariatric surgery is currently the most effective method of weight loss for individuals with obesity. However sustained weight loss after surgery can be hindered by unhealthy behaviours that have sustained since before the procedure. Motivational, educational, diet and exercise programmes have been shown to help sustain weight loss following surgery. This non-randomised control trial over 12 months, aimed to assess the effects of a motivational, educational diet and exercise programme on fitness and quality of life in 82 individuals following bariatric surgery. The results showed that a diet and exercise programme improved quality of life and fitness. There was an increased daily intake of fruits and vegetables, eating behaviours were improved and there was a greater weight loss in those following the programme. It was concluded that the diet and exercise programme was responsible for behavioural changes that ensured better quality of life and sustained weight loss following surgery. Health care professionals could use this study to understand the need to recommend motivational and educationally based diet and exercise programme to patients following bariatric surgery.
Abstract
INTRODUCTION Unhealthy lifestyles may hinder bariatric surgery outcomes. This non-randomized controlled study aimed to evaluate the effects of an integrated post-operative exercise-based educational and motivational program in improving behaviors, quality of life, anthropometric features, cardiorespiratory and physical fitness in bariatric patients respect to the only surgical intervention. METHODS A group of adult sedentary bariatric patients chose to attend a 12-month exercise program integrated with diet education and motivational support, or to receive usual care. Dietary habits, binge eating disorder, physical activity, obesity-related quality of life, Body Mass Index, waist and hip circumference, VO2max, strength and flexibility were assessed at the start and at the end of the study in both groups. RESULTS On a total of 82 patients enrolled, follow-up measures were obtained from 28 (85.7% females, mean age 38.2±8.7) and 42 (71.4% females, mean age 40.2±9.5) patients included in the intervention and control group, respectively. All the behavioral and physical outcomes improved significantly in the participants to the intervention, while the control group showed lesser changes, especially regarding quality of life and physical fitness. CONCLUSIONS Notwithstanding the self-selection, these results suggest that a timely postoperative behavioral multidisciplinary program for bariatric patients may be effective in establishing healthy behaviors which can lead to better surgery outcomes.
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Development and content validity of an instrument for assessing the motivation for weight loss in adolescents with overweight and obesity.
Silva, DFO, Souza, ALS, Pimentel, JB, Souza, TO, Araújo, EPDS, Sena-Evangelista, KCM, Arrais, RF, Lima, SCVC
PloS one. 2020;15(11):e0242680
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Reduction and control of body weight is an important measure in order to reduce health risks in adolescence and adulthood. The aim of this study was to develop and validate the content of an instrument to assess the motivation for weight loss in adolescents with overweight and obesity. This is a methodological study. The development and content validation of the instrument was conducted in five stages. There were three rounds of evaluation; in the first round the responses of 12 experts were included, in the second round the responses of 10 experts were included and in the final round the responses of four experts were included. Findings show that the content validity evaluation of the items by the panel of experts allowed the selection of the most practical items for adolescents. Additionally, the revisions made in the wording of the items provided a better standardization in the presentation of the items and a clearer language adapted to the age range of the target audience. Authors conclude that further psychometric testing is needed to determine reliability and construct validity of the instrument.
Abstract
OBJECTIVE To develop and validate the content of an instrument for assessing the motivation for weight loss in adolescents with overweight and obesity. METHODS The development and validation of the instrument were conducted in five stages, for which two systematic reviews were conducted. The first one, for the identification of questionnaires assessing the motivation for weight loss, included six studies and contributed to the selection of the domains for the instrument. The second one, conducted to identify the motivations for weight loss in adolescents with overweight and/or obesity, included six studies and contributed to the selection of 17 motivations included in the initial version of the instrument. The motivations most commonly identified were: having better health, improving my appearance, improving my self-esteem and avoiding bullying. The content validity was confirmed by a committee of 12 experts from the areas of nutrition, endocrinology, psychology, and physical education. Based on these evaluations, the content validity index was calculated. Only the items with a content validity index >0.80 for practical relevance were held in the instrument. RESULTS Five of the 17 motivations included in the initial version of the instrument were excluded because they had content validity index <0.80 for practical relevance. Of the 12 items held in the instrument, five were revised by experts in order to standardize wording and make the language more appropriate for adolescents. Experts categorized the items into the health, personal satisfaction, appearance and social domains. CONCLUSIONS This is the first instrument assessing the motivation for weight loss in adolescents with overweight and obesity in Brazil. The content validity evaluation by the panel of experts provided more practical relevance, as well as contributed to a better presentation of the items. Further psychometric testing is needed to determine reliability and construct validity of the instrument.