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DiAlert: a prevention program for overweight first degree relatives of type 2 diabetes patients: results of a pilot study to test feasibility and acceptability
Heideman Wieke H,de Wit Maartje,Middelkoop Barend JC,Nierkens Vera
Trials , 2012, DOI: 10.1186/1745-6215-13-178
Abstract: Background Prevalence of type 2 diabetes mellitus is increasing due to lifestyle changes, particularly affecting those genetically at risk. We developed DiAlert as a targeted group-based intervention aimed to promote intrinsic motivation and action planning for lifestyle changes and weight loss in first degree relatives of patients with type 2 diabetes mellitus. The main objective of the pilot of the DiAlert intervention was to assess fidelity, feasibility and acceptability prior to starting the randomized controlled trial. Methods Individuals with a family history of type 2 diabetes mellitus were self-identified and screened for eligibility. DiAlert consists of two group sessions. Feasibility, fidelity, acceptability and self-reported perceptions and behavioral determinants were evaluated in a pre-post study using questionnaires and observations. Determinants of behavior change were analyzed using paired-samples t tests and Wilcoxon signed rank tests. Results DiAlert was delivered to two groups of first degree relatives of patients with type 2 diabetes mellitus (N = 9 and N = 12). Feasibility and fidelity were confirmed. Overall, the DiAlert group sessions were positively evaluated (8.0 on a scale of 1 to 10) by participants. The intervention did not impact perceived susceptibility or worry about personal diabetes risk. Action planning with regard to changing diet and physical activity increased. Conclusions DiAlert proved feasible and was well-accepted by participants. Positive trends in action planning indicate increased likelihood of actual behavior change following DiAlert. Testing the effectiveness in a randomized controlled trial is imperative. Trial registration Netherlands National Trial Register (NTR): NTR2036
ALIFE@Work: a randomised controlled trial of a distance counselling lifestyle programme for weight control among an overweight working population [ISRCTN04265725]
Marieke F van Wier, Geertje AM Ari?ns, Johanna C Dekkers, Ingrid JM Hendriksen, Nico P Pronk, Tjabe Smid, Willem van Mechelen
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-140
Abstract: ALIFE@Work is a controlled trial, with randomisation to three arms: a control group, a phone based intervention group and an internet based intervention group. The intervention takes six months and is based on a cognitive behavioural approach, addressing physical activity and diet. It consists of 10 lessons with feedback from a personal counsellor, either by phone or e-mail, between each lesson. Lessons contain educational content combined with behaviour change strategies. Assignments in each lesson teach the participant to apply these strategies to every day life.The study population consists of employees from seven Dutch companies. The most important inclusion criteria are having a body mass index (BMI) ≥ 25 kg/m2 and being an employed adult.Primary outcomes of the study are body weight and BMI, diet and physical activity. Other outcomes are: perceived health; empowerment; stage of change and self-efficacy concerning weight control, physical activity and eating habits; work performance/productivity; waist circumference, sum of skin folds, blood pressure, total blood cholesterol level and aerobic fitness. A cost-utility- and a cost-effectiveness analysis will be performed as well.Physiological outcomes are measured at baseline and after six and 24 months. Other outcomes are measured by questionnaire at baseline and after six, 12, 18 and 24 months.Statistical analyses for short term (six month) results are performed with multiple linear regression. Analyses for long term (two year) results are performed with multiple longitudinal regression. Analyses for cost-effectiveness and cost-utility are done at one and two years, using bootstrapping techniques.ALIFE@Work will make a substantial contribution to the development of cost-effective weight control- and lifestyle interventions that are applicable to and attractive for the large population at risk.As is the global trend, more than 5.6 million adults in the Netherlands (i.e., 46.1% of the population of 20 years and ol
Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis
Eugene Oteng-Ntim, Rajesh Varma, Helen Croker, Lucilla Poston, Pat Doyle
BMC Medicine , 2012, DOI: 10.1186/1741-7015-10-47
Abstract: A systematic review and meta-analyses of randomised and non-randomised clinical trials following prior registration (CRD420111122 http://www.crd.york.ac.uk/PROSPERO webcite) and PRISMA guidelines was employed. A search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, Maternity and Infant care and eight other databases for studies published prior to January 2012 was undertaken. Electronic literature searches, study selection, methodology and quality appraisal were performed independently by two authors. Methodological quality of the studies was assessed according to Cochrane risk of bias tool. All appropriate randomised and non-randomised clinical trials were included while exclusions consisted of interventions in pregnant women who were not overweight or obese, had pre-existing diabetes or polycystic ovarian syndrome, and systematic reviews. Maternal outcome measures, including maternal gestational weight gain, gestational diabetes and Caesarean section, were documented. Fetal outcomes, including large for gestational age and macrosomia (birth weight > 4 kg), were also documented.Thirteen randomised and six non-randomised clinical trials were identified and included in the meta-analysis. The evidence suggests antenatal dietary and lifestyle intervention in obese pregnant women reduces maternal pregnancy weight gain (10 randomised clinical trials; n = 1228; -2.21 kg (95% confidence interval -2.86 kg to -1.59 kg)) and a trend towards a reduction in the prevalence of gestational diabetes (six randomised clinical trials; n = 1,011; odds ratio 0.80 (95% confidence interval 0.58 to 1.10)). There were no clear differences reported for other outcomes such as Caesarean delivery, large for gestational age, birth weight or macrosomia. All available studies were assessed to be of low to medium quality.Antenatal lifestyle intervention is associated with restricted gestational weight gain and a trend towards a reduced prevalence of gestational diabetes in the overweight and obes
The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomised controlled trial  [cached]
IJzelenberg Wilhelmina,Hellemans Irene M,van Tulder Maurits W,Heymans Martijn W
BMC Cardiovascular Disorders , 2012, DOI: 10.1186/1471-2261-12-71
Abstract: Background The additional benefit of lifestyle interventions in patients receiving cardioprotective drug treatment to improve cardiovascular risk profile is not fully established. The objective was to evaluate the effectiveness of a target-driven multidisciplinary structured lifestyle intervention programme of 6 months duration aimed at maximum reduction of cardiovascular risk factors in patients with cardiovascular disease (CVD) compared with usual care. Methods A single centre, two arm, parallel group randomised controlled trial was performed. Patients with stable established CVD and at least one lifestyle-related risk factor were recruited from the vascular and cardiology outpatient departments of the university hospital. Blocked randomisation was used to allocate patients to the intervention (n = 71) or control group (n = 75) using an on-site computer system combined with allocations in computer-generated tables of random numbers kept in a locked computer file. The intervention group received the comprehensive lifestyle intervention offered in a specialised outpatient clinic in addition to usual care. The control group continued to receive usual care. Outcome measures were the lifestyle-related cardiovascular risk factors: smoking, physical activity, physical fitness, diet, blood pressure, plasma total/HDL/LDL cholesterol concentrations, BMI, waist circumference, and changes in medication. Results The intervention led to increased physical activity/fitness levels and an improved cardiovascular risk factor profile (reduced BMI and waist circumference). In this setting, cardiovascular risk management for blood pressure and lipid levels by prophylactic treatment for CVD in usual care was already close to optimal as reflected in baseline levels. There was no significant improvement in any other risk factor. Conclusions Even in CVD patients receiving good clinical care and using cardioprotective drug treatment, a comprehensive lifestyle intervention had a beneficial effect on some cardiovascular risk factors. In the present era of cardiovascular therapy and with the increasing numbers of overweight and physically inactive patients, this study confirms the importance of risk factor control through lifestyle modification as a supplement to more intensified drug treatment in patients with CVD. Trial registration ISRCTN69776211 at http://www.controlled-trials.com
Assessing the efficacy of the healthy eating and lifestyle programme (HELP) compared with enhanced standard care of the obese adolescent in the community: study protocol for a randomized controlled trial
Deborah Christie, Lee Hudson, Anne Mathiot, Tim J Cole, Saffron Karlsen, Anthony Kessel, Sanjay Kinra, Steve Morris, Irwin Nazareth, Ulla Sovio, Ian CK Wong, Russell M Viner
Trials , 2011, DOI: 10.1186/1745-6215-12-242
Abstract: The study will evaluate the management of adolescent obesity by conducting a Medical Research Council complex intervention phase III efficacy randomised clinical trial of the Healthy Eating Lifestyle Programme within primary care. The study tests a community delivered multi-component intervention designed for adolescents developed from best practice as identified by National Institute for Health and Clinical Excellence. The hospital based pilot reduced body mass index and improved health-related quality of life.Subjects will be individually randomised to receiving either the Healthy Eating Lifestyle Programme (12 fortnightly family sessions) or enhanced standard care. Baseline and follow up assessments will be undertaken blind to allocation status. A health economic evaluation is also being conducted.200 obese young people (13-17 years, body mass index > 98th centile for age and sex) will be recruited from primary care within the greater London area.The primary hypothesis is that a motivational and solution-focused family-based weight management programme delivered over 6 months is more efficacious in reducing body mass index in obese adolescents identified in the community than enhanced standard care.The primary outcome will be body mass index at the end of the intervention, adjusted for baseline body mass index, age and sex.The secondary hypothesis is that the Healthy Eating Lifestyle Programme is more efficacious in improving quality of life and psychological function and reducing waist circumference and cardiovascular risk factors in obese adolescents than enhanced standard care assessed at 6 and 12 months post baseline assessment.Improvement in quality of life predicts on-going lifestyle change and maximises the chances of long-term weight reduction. We will explore whether improvement in QOL may be intermediate on the pathway between the intervention and body mass index change.ISRCTN: ISRCTN99840111The obesity epidemic in children and young people is one of th
Patient recall of receiving lifestyle advice for overweight and hypertension from their General Practitioner
Alison O Booth, Caryl A Nowson
BMC Family Practice , 2010, DOI: 10.1186/1471-2296-11-8
Abstract: A face to face survey was conducted on a representative sample (urban, suburban and rural) of South Australian residents. Respondents provided information on height and weight (self-report), whether they had received lifestyle advice from their GP for weight loss, and for those with self reported hypertension if they had received advice to reduce dietary salt.The sample included 2947 South Australian adult residents (58% female; BMI (mean (SD)), 26.6 (5.3) kg/m2; age, 50.7 (18.0) years). Ninety-six percent had visited their GP in the past 12 months. Forty-one percent of males and 25% of females were overweight and 19% of males and 20% of females were obese. Twenty-seven percent of overweight/obese respondents reported receiving lifestyle advice for weight loss purposes. Of the 33% who reported they had hypertension, 34% reported receiving advice to reduce salt intake.Less than 1/3 of overweight/obese patients reported that they had received lifestyle advice that could assist with weight loss from their GP. About a third of respondents with hypertension reported that they received advice to reduce salt intake. There are potentially missed opportunities in which GPs could provide re-enforcement of benefits of lifestyle changes with respect to weight and blood pressure control.Ischaemic heart disease and strokes are the leading causes of death in Australia accounting for 24% of total deaths in 2007[1]. Two of the major risk factors for heart disease and strokes are hypertension and a high body mass index. In Australia, 42% of males and 31% of females were overweight and 26% of males and 24% of females were obese in 2007-08[2]. In 2007-08, 9% of all Australian adults and 39% of those aged over 75 years had high blood pressure[2].Overweight, obesity and hypertension can be prevented through improvements in lifestyle including nutrition and physical activity. There is a clear association between excessive energy intake and low levels of physical activity and overweight/ob
The LIFESTYLE study: costs and effects of a structured lifestyle program in overweight and obese subfertile women to reduce the need for fertility treatment and improve reproductive outcome. A randomised controlled trial
Meike AQ Mutsaerts, Henk Groen, Nancy CW ter Bogt, Johanna HT Bolster, Jolande A Land, Wanda JE Bemelmans, Walter KH Kuchenbecker, Peter GA Hompes, Nick S Macklon, Ronald P Stolk, Fulco van der Veen, Jacques WM Maas, Nicole F Klijn, Eugenie M Kaaijk, Gerrit JE Oosterhuis, Peter XJM Bouckaert, Jaap M Schierbeek, Yvonne M van Kasteren, Annemiek W Nap, Frank J Broekmans, Egbert A Brinkhuis, Carolien AM Koks, Jan M Burggraaff, Adrienne S Blankhart, Denise AM Perquin, Marie H Gerards, Robert JAB Mulder, Ed TCM Gondrie, Ben WJ Mol, Annemieke Hoek
BMC Women's Health , 2010, DOI: 10.1186/1472-6874-10-22
Abstract: Multicenter randomised controlled trial in subfertile women (age 18-39 year) with a body mass index between 29 and 40 kg/m2. Exclusion criteria are azoospermia, use of donor semen, severe endometriosis, premature ovarian failure, endocrinopathies or pre-existent hypertensive disorders.In the intervention group the aim is a weight loss of at least 5% to10% in a six-month period, to be achieved by the combination of a diet, increase of physical activity and behavioural modification. After six months, in case no conception has been achieved, these patients will start fertility treatment according to the Dutch fertility guidelines. In the control group treatment will be started according to Dutch fertility guidelines, independently of the patient's weight.The primary outcome measure is a healthy singleton born after at least 37 weeks of gestation after vaginal delivery. Secondary outcome parameters including pregnancy outcome and complications, percentage of women needing fertility treatment, clinical and ongoing pregnancy rates, body weight, quality of life and costs.Data will be analysed according to the intention to treat principle, and cost-effectiveness analysis will be performed to compare the costs and health effects in the intervention and control group.The trial will provide evidence for costs and effects of a lifestyle intervention aiming at weight reduction in overweight and obese subfertile women and will offer guidance to clinicians for the treatment of these patients.Dutch Trial Register NTR1530There is indisputable evidence for the adverse effects of overweight and obesity on women's reproductive health. Overweight and obesity affect reproductive capacity in the general population [1] as well as in subfertile couples [2]. Ovulatory subfertile women with a body mass index (BMI) of 29 kg/m2 or higher have a 4% lower pregnancy rate per kg/m2 increase per year, compared to ovulatory subfertile women with a BMI below 29. In the Netherlands, approximately 30% o
The design of a community lifestyle programme to improve the physical and psychological well-being of pregnant women with a BMI of 30 kg/m2 or more
Debbie M Smith, Melissa Whitworth, Colin Sibley, Wendy Taylor, Jane Gething, Catherine Chmiel, Tina Lavender
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-284
Abstract: Four hundred women will be approached to attend a 10-week community lifestyle programme. The programme will be provided as a supplement to standard antenatal care. The programme is multi-faceted, aimed at equipping participants with the skills and knowledge needed to adopt healthy behaviours. The social (cognitive) learning theory will be used as a tool to encourage behaviour change, the behaviour change techniques are underpinned by five theoretical components; self-efficacy, outcome expectancies, goal setting, feedback and positive reinforcement.The main outcomes are pregnancy weight gain and caesarean section rate. Other important outcomes include clinical outcomes (e.g., birth weight) and psychological outcomes (e.g., well-being). Secondary outcomes include women's experience of pregnancy and health care services, amount of physical activity, food intake and the suitability of the intervention components.A prospective study using quantitative and qualitative methods will inform the feasibility of implementing the community lifestyle programme with pregnant women with a BMI of 30 kg/m2 or more. Mixed methods of data collection will be used, including diaries, focus groups/interviews, pedometers, validated and specifically designed questionnaires, a programme register, weight gain during pregnancy and perinatal outcome data.Findings from this current feasibility study will inform future interventions and NHS services and add to the evidence-base by providing information about the experiences of pregnant women with a BMI of 30 kg/m2 or more undertaking a community lifestyle programme. The study will lead on to a randomised control trial of a suitable intervention to improve the pregnancy outcomes of this target group.ISRCTN29860479.A body mass index (BMI) of 30 kg/m2 or more is classified clinically as obese, a BMI of 35 or more is morbidly obesity and a BMI of 40 or more indicates extreme obesity (World Health Organisation, 1998). Obesity is a global epidemic [1]
Should public health interventions aimed at reducing childhood overweight and obesity be gender-focused?
Aline Simen-Kapeu, Paul J Veugelers
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-340
Abstract: In 2008, we surveyed 3421 grade five students and their parents of 148 randomly selected schools. Students completed the Harvard food frequency questionnaire, questions on physical activities, and had their height and weight measured. Parents completed questions on socio-economic background and child's lifestyle. We applied multilevel regression methods to assess gender differentials in overweight, nutrition and physical activity.Overall, the prevalence of overweight was slightly higher among boys (29.1%) than girls (27.9%) with more pronounced differences in towns and urban geographies. Boys reported to be much more physically active relative to girls (OR = 2.12, 95% CI: 1.73-2.60). Diets of boys, relative to those of girls, reportedly constituted more fat and were less likely to meet the recommendation of 6 daily servings of vegetables and fruits (OR = 0.81, 95% CI: 0.71-0.93).Our findings confirm the existence of gender differences in physical activity and nutrition, and support gender-focused health promotion whereby priority is given to physical activity among girls and to healthy eating among boys.The prevention of childhood overweight and obesity is a public health priority in developed countries [1]. Unhealthy diets and physical inactivity are the established determinants of the rising prevalence of overweight and obesity in childhood [2,3]. Research of these determinants has become increasingly important due to the increasing recognition of the need for preventative actions. For example, childhood overweight has been reported to vary between geographies, with higher prevalence rates observed in rural areas relative to urban areas in most developed countries, suggesting that priority for programs should be given to children and youth residing in rural areas [4].The etiology of overweight and obesity among girls and boys may be different due to biology (sex differences) as well as society and culture (gender differences) [5,6]. Various studies have examined t
Overweight and lifestyle behaviors of low socioeconomic elementary school children in Buenos Aires
Valeria Hirschler, Karina Buzzano, Anabella Erviti, Noemi Ismael, Silvina Silva, Ricardo Dalamon
BMC Pediatrics , 2009, DOI: 10.1186/1471-2431-9-17
Abstract: 330 students (168M) aged 8.9 + 2 y from 4 suburban Buenos Aires elementary schools, and their mothers aged 36.2 + 7 y were examined between April and September 2007. Mothers were asked about their children s lifestyle. Data included parental education levels socioeconomic status, mothers and children s BMI, and Tanner stage.All families were in the low socio-economic class. 79% of parents had an elementary education or less. 61 (18.5%) of children were obese (OB) (BMI>95%ile per CDC norms), and 53 (16.1%) overweight (OW) (BMI>85<95%ile). 103 (31.2%) of mothers were OB (BMI>30 kg/m2), and102 (30.9%) OW (BMI>25<30). 63% the children were pre-pubertal. 40% had a TV set in their bedroom. 13% of the children skipped breakfast and only 38% watched TV ≤2 hours daily, as recommended. Multiple logistic regression analysis showed a positive association between children s OW/OB and drinking sweetened beverages (OR = 1.24; 95% CI, 1.02–1.52), TV viewing (OR = 1.30; 95% CI,1.05–1.62), and maternal BMI (OR: 1.07; 95% CI,1.02–1.12), and a negative association with eating breakfast (OR = 0.43; 95% CI, 0.19–0.97) adjusted for fruit and vegetables consumption, milk consumption, maternal educational level and socioeconomic class.Our results suggest that TV viewing, drinking sweet beverages, skipping breakfast, and maternal BMI are important predictive variables for childhood OW/OB.The rise in the prevalence of overweight and obesity (OW/OB) in children is one of the most alarming public health issues facing the world today. Child OB and its consequences threaten the health of today's children to such an extent that they may, have a shorter lifespan than their parents [1]. Although the causes of OB in children are multifaceted, the recent upsurge in pediatric OB could be explained by changes in the availability of high caloric 'fast' food, pre-prepared meals, and soft drinks, an increase in time spent watching television, playing video games and using the internet, and a decrease in th
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