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Randomized Trial Examining the Effect of a 12-wk Exercise Program on Hedonic Eating.
Unick, JL, Dunsiger, SI, Leblond, T, Hahn, K, Thomas, JG, Abrantes, AM, Stroud, LR, Wing, RR
Medicine and science in sports and exercise. 2021;(8):1638-1647
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Abstract
PURPOSE This efficacy trial tests the hypothesis that exercise training favorably affects hedonic eating (i.e., overeating, stress-induced overeating, disinhibited eating, eating when tempted), in a sample of women who are overweight or obese. METHODS Participants were inactive at baseline, self-identified as "stress eaters," and were randomized to 12 wk of moderate-intensity exercise training (EX; combination of supervised and objectively confirmed unsupervised sessions) or to a no-exercise control condition (CON). EX participants were given an exercise goal of 200 min·wk-1. No dietary instructions or weight control strategies were provided. Assessments occurred at baseline and 12 wk. Overeating episodes, stress-induced overeating, and dietary temptations were measured over 14 d at each assessment using ecological momentary assessment. Disinhibition and dietary restraint were assessed via a questionnaire. RESULTS Forty-nine participants (age, 40.4 ± 10.8 yr; body mass index, 32.4 ± 4.1 kg·m-2) enrolled, and 39 completed this study. Adherence to the exercise intervention was high (99.4% of all prescribed exercise). At week 12, the proportion of eating episodes that were characterized as overeating episodes was lower in EX versus CON (21.98% in EX vs 26.62% in control; P = 0.001). Disinhibition decreased in EX but not in CON (P = 0.02) and was driven by internal factors. There was a trend such that CON was more likely to give into dietary temptations (P = 0.08). Stress-induced overeating was low and did not differ between conditions (P = 0.61). CONCLUSIONS Exercise training reduced the likelihood of overeating and eating in response to internal cues in women who self-identified as stress eaters. This may be one pathway by which exercise affects body weight.
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Evaluation of intervention components to maximize outcomes of behavioral obesity treatment delivered online: A factorial experiment following the multiphase optimization strategy framework.
Thomas, JG, Goldstein, CM, Bond, DS, Lillis, J, Hekler, EB, Emerson, JA, Espel-Huynh, HM, Goldstein, SP, Dunsiger, SI, Evans, EW, et al
Contemporary clinical trials. 2021;:106217
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BACKGROUND Behavioral lifestyle intervention (BLI) is recommended as a first-line treatment for obesity. While BLI has been adapted for online delivery to improve potential for dissemination while reducing costs and barriers to access, weight losses are typically inferior to gold standard treatment delivered in-person. It is therefore important to refine and optimize online BLI in order to improve the proportion of individuals who achieve a minimum clinically significant weight loss and mean weight loss. STUDY DESIGN Five experimental intervention components will be tested as adjuncts to an established 12-month online BLI: virtual reality for BLI skills training, interactive video feedback, tailored intervention to promote physical activity, skills for dysregulated eating, and social support combined with friendly competition. Following the Multiphase Optimization Strategy (MOST) framework, the components will first be refined and finalized during Preparation Phase pilot testing and then evaluated in a factorial experiment with 384 adults with overweight or obesity. A priori optimization criteria that balance efficacy and efficiency will be used to create a finalized treatment package that produces the best weight loss outcomes with the fewest intervention components. Mediation analysis will be conducted to test hypothesized mechanisms of action and a moderator analysis will be conducted to understand for whom and under what circumstances the interventions are effective. CONCLUSION This study will provide important information about intervention strategies that are useful for improving outcomes of online BLI. The finalized treatment package will be suitable for testing in a future randomized trial in the MOST Evaluation Phase.
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Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial.
Goldstein, SP, Zhang, F, Klasnja, P, Hoover, A, Wing, RR, Thomas, JG
JMIR research protocols. 2021;(12):e33568
Abstract
BACKGROUND Behavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT. OBJECTIVE The aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions. METHODS Adults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment. RESULTS The recruitment for the microrandomized trial began on April 19, 2021, and is ongoing. CONCLUSIONS This study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss). TRIAL REGISTRATION ClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33568.
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Refining an algorithm-powered just-in-time adaptive weight control intervention: A randomized controlled trial evaluating model performance and behavioral outcomes.
Goldstein, SP, Thomas, JG, Foster, GD, Turner-McGrievy, G, Butryn, ML, Herbert, JD, Martin, GJ, Forman, EM
Health informatics journal. 2020;(4):2315-2331
Abstract
Suboptimal weight losses are partially attributable to lapses from a prescribed diet. We developed an app (OnTrack) that uses ecological momentary assessment to measure dietary lapses and relevant lapse triggers and provides personalized intervention using machine learning. Initially, tension between user burden and complete data was resolved by presenting a subset of lapse trigger questions per ecological momentary assessment survey. However, this produced substantial missing data, which could reduce algorithm performance. We examined the effect of more questions per ecological momentary assessment survey on algorithm performance, app utilization, and behavioral outcomes. Participants with overweight/obesity (n = 121) used a 10-week mobile weight loss program and were randomized to OnTrack-short (i.e. 8 questions/survey) or OnTrack-long (i.e. 17 questions/survey). Additional questions reduced ecological momentary assessment adherence; however, increased data completeness improved algorithm performance. There were no differences in perceived effectiveness, app utilization, or behavioral outcomes. Minimal differences in utilization and perceived effectiveness likely contributed to similar behavioral outcomes across various conditions.
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DIAL now protocol: A randomized trial examining the provision of phone coaching to those with sub-optimal early weight loss during an Internet weight management program.
Unick, JL, Pellegrini, CA, Dunsiger, SI, Demos, KE, Thomas, JG, Bond, DS, Webster, J, Wing, RR
Contemporary clinical trials. 2020;:105953
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BACKGROUND While low-intensity Internet-delivered weight loss (IDWL) programs are efficacious, many patients fail to achieve clinically significant weight loss (WL). Given the positive association between 4-week and post-treatment WL, providing a more intensive intervention for those with sub-optimal 4-week WL may improve outcomes for a greater proportion of individuals. This stepped-care approach would minimize cost by reserving more aggressive treatment for those with sub-optimal early WL. OBJECTIVE This randomized trial examines whether the provision of brief or extended phone coaching for those with sub-optimal early WL improves 4- and 12-month WL when compared to no coaching. Secondary aims include examination of cost/kg WL and intervention engagement. METHODS 450 individuals (age 18-70 years, BMI: 25-45 kg/m2) will be randomized to: 1) IDWL+3 weeks of coaching ('Brief'), 2) IDWL+12 weeks of coaching ('Extended'), or 3) IDWL only ('Control'). All individuals will receive a 4-month IDWL program followed by an 8-month IDWL maintenance program. At week 4, individuals will be classified as early sub-optimal responders (<4% WL) or initial responders (≥4% WL). Individuals with sub-optimal early WL randomized to 'Brief' or 'Extended' will receive 3 and 12 weeks of phone coaching respectively, starting at week 5. Those with sub-optimal early WL randomized to 'Control', and initial responders will not receive any coaching. Assessments will occur at 4 and 12 months. DISCUSSION Study findings can inform the development of more effective IDWL programs. This model which provides additional support to those with sub-optimal early WL can easily be translated into healthcare and community settings.
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Consistent Morning Exercise May Be Beneficial for Individuals With Obesity.
Schumacher, LM, Thomas, JG, Raynor, HA, Rhodes, RE, Bond, DS
Exercise and sport sciences reviews. 2020;(4):201-208
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This review explores the hypothesis that a consistent exercise time, especially consistent morning exercise, improves exercise adherence and weight management for individuals with overweight or obesity. We discuss data supporting this premise, identify limitations of current research, and outline directions for future research on exercise timing to more robustly evaluate our thesis.
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Examining the pattern of new foods and beverages consumed during obesity treatment to inform strategies for self-monitoring intake.
Raynor, HA, Thomas, JG, Cardoso, CC, Wojtanowski, AC, Foster, GD
Appetite. 2019;:147-153
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Maintaining dietary self-monitoring during obesity treatment may improve outcomes. As dietary variety is associated with energy intake, understanding the pattern of when new foods and beverages are consumed may assist with identifying when self-monitoring should occur. This study examined dietary variety (total number of differing foods and beverages consumed) from the first 40 days of self-monitoring records reporting ≥ 3 eating occasions and >600 kcal/day from 60 adults (55.9 ± 9.1 yrs, 35.1 ± 5.3 kg/m2, 80.0% female, 95.0% white) participating in a smartphone-based, lifestyle intervention. Dietary variety was coded using an ingredient-based approach. Additionally, new flavors of previously consumed items, and modified and non-modified items contributed to variety. Total number of different foods and beverages consumed over 40 coded days (cumulative variety [cv40]); number of days to reach 50%, 75%, and 100% of cv40; cv40 by eating occasions; and mean number of new items consumed on weekdays and weekend days were calculated. CV40 was 145.4 ± 33.5. Number of coded days to consume 50%, 75%, and 100% of cv40 was 12.7, 25.1, and 40.0, respectively. Dinner was greater (p < 0.0001) in cv40 (58.6 ± 18.5 different items) than other eating occasions, and lunch was greater (p < 0.0001) (38.8 ± 10.7 different items) than breakfast and snack. Weekend days had a greater mean number of new items consumed than weekdays, (3.8 ± 1.0 items vs. 3.6 ± 0.9 items, p = 0.035). Variety of items consumed during obesity treatment is high, and to capture the majority of differing items consumed, at least 4 weeks of detailed recording is needed. After this, to capture new foods and beverages consumed, self-monitoring dinners, lunch, and weekend days may be helpful.
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Comparison of Smartphone-Based Behavioral Obesity Treatment With Gold Standard Group Treatment and Control: A Randomized Trial.
Thomas, JG, Bond, DS, Raynor, HA, Papandonatos, GD, Wing, RR
Obesity (Silver Spring, Md.). 2019;(4):572-580
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OBJECTIVE This study aimed to determine whether weight losses from a primarily smartphone-based behavioral obesity treatment (SMART) differed from those of a more intensive group-based behavioral obesity treatment (GROUP) and a control condition (CONTROL). METHODS A total of 276 adults with overweight/obesity were randomly assigned to 18 months of GROUP-based treatment with meetings weekly for 6 months, meetings biweekly for 6 months, and meetings monthly for 6 months and self-monitoring via paper diaries with written feedback; SMART-based treatment with online lessons, self-monitoring, and feedback plus monthly weigh-ins; or a CONTROL condition with self-monitoring via paper diaries with written feedback and monthly weigh-ins. RESULTS Among the 276 participants (17% men; 7.2% minority; mean [SD] age: 55.1 [9.9] years; weight: 95.9 [17.0] kg; BMI: 35.2 [5.0] kg/m2 ), 18-month retention was significantly higher in both GROUP (83%) and SMART (81%) compared with CONTROL (66%). Estimated mean (95% CI) weight change over 18 months did not differ across the three conditions: 5.9 kg (95% CI: 4.5-7.4) in GROUP, 5.5 kg (95% CI: 3.9-7.1) in SMART, and 6.4 kg (95% CI: 3.7-9.2) in CONTROL. CONCLUSIONS Mobile online delivery of behavioral obesity treatment can achieve weight loss outcomes that are at least as good as those obtained via the more intensive gold standard group-based approach.
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Associations between self-monitoring and weight change in behavioral weight loss interventions.
Goldstein, SP, Goldstein, CM, Bond, DS, Raynor, HA, Wing, RR, Thomas, JG
Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2019;(12):1128-1136
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OBJECTIVE The current study is a secondary analysis of the Live SMART trial, a randomized controlled trial comparing a behavioral weight loss (BWL) condition delivered via smartphone (SMART) to a group-based BWL condition (GROUP) and a control condition (CONTROL). Given the established importance of self-monitoring for weight loss, the aims were to evaluate bidirectional associations between adherence to self-monitoring and weight change and to examine the moderating effect of treatment condition on these associations. METHOD Adults with overweight/obesity (n = 276; 83% women; 92.8% White; Mage = 55.1 years; Mbody mass index = 35.2 kg/m2) were instructed to self-monitor dietary intake, daily weight, and physical activity minutes via paper diaries in GROUP and CONTROL and via a smartphone application in SMART. All participants were weighed monthly at the research center. Adherence to self-monitoring was assessed via examination of self-monitoring records. RESULTS Generalized linear mixed models revealed that adherence to self-monitoring of dietary intake, self-weighing, and physical activity for each month was associated with weight change throughout that month, such that increased frequency of self-monitoring led to greater weight loss (ps < .001). For the GROUP condition only, poorer weight losses in 1 month were prospectively associated with poor adherence to self-monitoring the following month (ps ≤ .01). CONCLUSIONS Results provide evidence of a bidirectional association between self-monitoring and weight change. Better self-monitoring was consistently associated with better weight loss across intervention and tracking modalities. Poorer weight loss was prospectively associated with poorer self-monitoring in group treatment, suggesting that social influences could drive adherence in this form of treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Behavioral Weight Loss Intervention for Migraine: A Randomized Controlled Trial.
Bond, DS, Thomas, JG, Lipton, RB, Roth, J, Pavlovic, JM, Rathier, L, O'Leary, KC, Evans, EW, Wing, RR
Obesity (Silver Spring, Md.). 2018;26(1):81-87
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Plain language summary
Migraine is a neurological disease characterized by moderate-to-severe headache and accompanying autonomic, affective, and sensory features. It is also comorbid with several diseases, including obesity. The aim of this study was to assess the impact of a standardized behavioural weight loss (BWL) intervention on migraine headache frequency. This study is a parallel-group, single-blinded randomised controlled trail. The participants were randomized to one of the two groups: BWL or migraine education (ME). Results show that changes in migraine headache frequency at post-treatment and follow-up were not significantly different between the BWL and ME control interventions. In fact, both BWL and ME had significant reductions in monthly migraine headache days from baseline to post-treatment and follow-up. Authors conclude that further research is required to better understand treatment mechanisms and whether BWL can enhance effects of standard pharmacologic and/or non-pharmacologic migraine therapies in patients with comorbid overweight/obesity.
Abstract
OBJECTIVE The objective of this study was to test whether behavioral weight loss (BWL) intervention decreases headaches in women with comorbid migraine and overweight or obesity. METHODS This randomized, single-blind trial allocated women 18 to 50 years old with 4 to 20 migraine days per month and a BMI = 25.0-49.9 kg/m2 to 16 weeks of BWL (n = 54), which targeted exercise and eating behaviors for weight loss, or to migraine education control (ME, n = 56), which delivered didactic instruction on migraine and treatments. Participants completed a 4-week smartphone headache diary at baseline, posttreatment (16-20 wk), and follow-up (32-36 wk). The primary outcome was posttreatment change in migraine days per month, analyzed via linear mixed effects models. RESULTS Of 110 participants randomly assigned, 85 (78%) and 80 (73%) completed posttreatment and follow-up. Although the BWL group achieved greater weight loss (mean [95% CI] in kilograms) than the ME group at posttreatment (-3.8 [-2.5 to -5.0] vs. + 0.9 [-0.4 to 2.2], P < 0.001) and follow-up (-3.2 [-2.0 to -4.5] vs. + 1.1 [-0.2 to 2.4], P < 0.001), there were no significant group (BWL vs. ME) differences (mean [95% CI]) in migraine days per month at posttreatment (-3.0 [-2.0 to -4.0] vs. -4.0 [-2.9 to -5.0], P = 0.185) or follow-up (-3.8 [-2.7 to -4.8] vs. -4.4 [-3.4 to -5.5], P = 0.378). CONCLUSIONS Contrary to hypotheses, BWL and ME yielded similar, sustained reductions in migraine headaches. Future research should evaluate whether adding BWL to standard pharmacological and/or nonpharmacological migraine treatment approaches yields greater benefits.