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Background: Regulatory focus theory proposes two self-regulatory systems: promotion focus-related to fulfilling aspirations and maximizing positive outcomes-and prevention focus-related to fulfilling responsibilities and avoiding negative outcomes. Building on research demonstrating associations between regulatory focus and weight outcomes, a proof-of-concept weight control intervention framed intervention procedures in terms of promotion or prevention focus and descriptively examined whether the impact of the intervention conditions depended on dispositional regulatory focus., Methods: After random assignment to control (received pamphlet on diet and physical activity), promotion, or prevention conditions (1.5-hour baseline sessions; detailed manuals; 1-hour sessions at 3 months), community participants from a metropolitan area in the United States (N = 57; age M = 40; BMI M = 30.9) completed the Regulatory Focus Questionnaire and were weighed at baseline, 3 months, and 6 months. Longitudinal analysis was conducted with SAS Proc Mixed using restricted maximum likelihood estimation., Results: Estimated weight change was -2.99 kg, 95% CI [-4.65, -1.32], in the promotion condition, -1.70 kg, 95% CI [-3.29, -0.12], in the prevention condition, and -0.18 kg, 95% CI [-1.42, 1.05], in the control condition. Exploratory analyses revealed that for relatively more promotion-focused participants, estimated weight change was -1.43 kg, 95% CI [-3.38, 0.51], in the promotion condition, +0.48 kg, 95% CI [-1.01, 1.97], in the prevention condition, and -1.09 kg, 95% CI [-2.32, 0.14], in the control condition. For relatively more prevention-focused participants, estimated weight change was -5.19 kg, 95% CI [-7.14, -3.25], in the promotion condition, -3.35 kg, 95% CI [-4.83, -1.86], in the prevention condition, and +0.42 kg, 95% CI [-0.81, 1.65], in the control condition., Conclusions: Results suggest that self-directed, promotion-focused interventions may be effective and that tailoring to self-regulatory dispositions may not be of additional benefit in initiating weight loss., (© 2023. International Society of Behavioral Medicine.)

Background: Little is known about parent outcomes of rural, family-focused childhood obesity prevention trials., Objective: Our aim was to evaluate parent outcomes of the rural, family-focused NU-HOME (New Ulm at HOME [Healthy Offerings via the Mealtime Environment]) randomized controlled trial designed to prevent obesity in children aged 7 through 10 years., Design: Families were randomized to the intervention or wait-list control group after baseline data collection. Staff measured parent height, weight, and percent body fat. Surveys measured parent cognitive and behavioral outcomes (eg, portion-size confidence, dietary intake, total and moderate-to-vigorous physical activity, and screen time). Post-intervention data were collected 8 to 10 months after baseline., Participants/setting: The randomized controlled trial took place in rural, south central Minnesota, and enrolled parent and child dyads (N = 114; 2017-2018); 98 parents provided data at post intervention (2018-2019) and comprise the analytic sample. Parent inclusion criteria were being the primary meal preparer, living with the child most of the time, and being willing to attend intervention sessions. Exclusion criteria were planning to move or having a medical condition that would contraindicate participation., Intervention: The theory-guided intervention (7 sessions and 4 goal-setting calls) focused on family eating and active living behaviors., Main Outcome Measures: Height, weight, and percent body fat were measured and the survey assessed diet, active living, and food-related outcomes., Statistical Analyses Performed: Multiple linear regression models tested change in parent outcomes from baseline to post intervention by treatment group adjusted for demographic characteristics and baseline values., Results: In the intervention group vs control group, parent total weekly hours of physical activity was 1.73 hours higher (95% CI 0.11 to 3.35 hours) and portion-size confidence was 1.49 points higher (95% CI 0.78 to 2.19). No other statistically significant changes were observed by treatment group., Conclusions: Findings indicate that parent cognitive and behavioral outcomes are amenable to change in family-focused childhood obesity prevention programs. Parent increases in portion-size confidence and total physical activity hours may support long-term parent health and provide positive context for child health., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

These analyses examined associations of parent dietary role modeling with diet quality among school-age children in a rural community. Past research has found protective associations between parent role modeling and children's dietary intake; however, there is a gap in understanding these associations for families in rural communities. Baseline data (2017 -2018) were drawn from the New Ulm at Home (NU-HOME) randomized controlled trial, conducted in the United States. The trial recruited 114 children (7-10 years old) and parents. Parents self-reported dietary intake [fruit and vegetable (FV), sugar-sweetened beverage (SSB), fast food (FF)] and frequency of sitting and eating with their child. Children reported parent role modeling of healthful eating (FV and salad at the evening meal; FV as snacks). Two 24-h dietary recalls assessed child diet quality indicators [Healthy Eating Index-2015 (HEI-2015) total scores, FV intake, SSB intake]. General linear models (GLM) and logistic regression analyzed associations of child diet quality (HEI score, FV intake, SSB intake) with parent dietary intake, parent sitting and eating the evening meal with their child, and child perceptions of parent role modeling healthful eating, adjusted for highest level of education in the home. Higher child HEI-2015 scores were positively associated with more frequent parent role modeling of fruit intake at meals, and inversely associated with more frequent parent role modeling of fruit as a snack; no significant associations of child FV intake with parent role modeling were observed. Higher child SSB intake was positively associated with parent FF intake. In this rural community, parents play significant roles in shaping children's dietary quality and intake, though more work needs to be done to address optimal intervention strategies to promote parent role modeling of healthful eating., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Family meal practices such as family member presence, fast food consumption and media usage have been associated with health outcomes. However, little is known about combinations of family meal practices and their effects on diet and health. This secondary data analysis aimed to identify patterns of family evening meal practices and examine their associations with family characteristics (e.g., demographics and chaos) and child and parent diet quality and weight-related outcomes. We used baseline data from a community-based randomized controlled trial with 7- to 10-year-old children and their parents in rural Minnesota (n = 114). Parent-reported structural (e.g. media usage) and interpersonal (e.g. mealtime routines) aspects of family evening meal practices were included in latent profile analyses to identify patterns. Diet quality was assessed by child Healthy Eating Index-2015 and parent fruit and vegetable intake. Weight-related outcomes were determined using measured body mass index (z-scores) and percent body fat. A 3-class model was the model of best-fit. The Unplanned Infrequent Family Evening Meals with Mixed Healthfulness class (C1) featured the least frequent family evening meals and the lowest scores for mealtime routines and planning skills. The Family Evening Meals with Fast Food class (C2) characterized having family evening meals four times a week, but fast food was often served. The Planful, Healthful and Frequent Family Evening Meals class (C3) reported the highest meal routine and planning scores as well as frequent family evening meals. Parents in C3 had higher consumption of fruits and vegetables and children in C3 had lower percent body fat, compared to those in other classes. Distinctly different patterns of family evening meal practices suggest a need for considering heterogeneity of family evening meal practices in developing tailored family-meal interventions., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Rural children are at greater obesity risk than their urban peers. The NU-HOME study is an innovative collaborative effort to prevent childhood obesity in rural communities. Weight outcomes of the NU-HOME study, a family-meal focused randomized controlled trial (RCT) are described. We hypothesized that compared to control group children, intervention group children would have significantly lower weight-related post-intervention (PI) outcomes., Methods: Participants were 114 dyads (7-10 year-old rural children and a parent). In 2017-2018 and 2018-2019, research staff measured height, weight and body fat at baseline (BL) and PI. Families were randomized to intervention (n = 58) or control (n = 56) groups without blinding. Designed with Social Cognitive Theory and community engagement, the NU-HOME program included seven monthly sessions delivered in community settings and four goal-setting calls. The program engaged entire families to improve healthy eating, physical activity, family meals and the home food environment. Multiple linear and logistic regression models tested PI outcomes of child BMIz-score, percent body fat, percent over 50th percentile BMI, and overweight/obesity status by treatment group, adjusted for BL values and demographics (n = 102)., Results: No statistically significant intervention effects were seen for child BMIz or overweight/obesity status. However, a promising reduction in boys' percent body fat (- 2.1, 95% CI [- 4.84, 0.63]) was associated with the intervention., Conclusions: Although our findings were in the hypothesized direction, making significant impacts on weight-related outcomes remains challenging in community trials. Comprehensive family-focused programming may require intensive multi-pronged interventions to mitigate complex factors associated with excess weight gain., Clinical Trial Registration: This study is registered with NIH ClinicalTrials.gov: NCT02973815 ., (© 2022. The Author(s).)

Purpose: Body dissatisfaction is ubiquitous in our society and leads to eating disorders. Longitudinal research suggests that higher body dissatisfaction predicts higher negative affect and unhealthy weight control behaviors over time. However, no study has assessed how body dissatisfaction impacts affect and weight control behaviors in the moment. In the current study, we examined the momentary relationships between body dissatisfaction, affect and weight control behaviors using ecological momentary assessment., Methods: Female college students (N = 67) completed measures of state body dissatisfaction, affect, and weight control behaviors across fourteen days using ecological momentary assessment., Results: Greater body dissatisfaction significantly predicted lower subsequent positive affect and higher subsequent negative affect, but positive and negative affect did not predict subsequent body dissatisfaction. Daily average body dissatisfaction was not significantly associated with daily engagement in either healthy or unhealthy weight control behaviors., Conclusion: Short-term negative effects of body dissatisfaction on affect were apparent. Targeting body dissatisfaction may be important for improving affect., Level of Evidence: Level IV, multiple time series without intervention., (© 2020. Springer Nature Switzerland AG.)

Purpose: The relationships between momentary affect and weight control behaviors have been extensively studied in samples of individuals with eating disorders, but we do not know that the established relationships translate to healthy college women. The current study examined the relationship between affect and weight control behaviors in healthy college women., Method: Female college students (N = 67) completed measures of negative affect, positive affect, healthy weight control behaviors, and unhealthy weight control behaviors across fourteen days using ecological momentary assessment., Results: Average daily negative affect was inversely associated with daily engagement in unhealthy weight control behaviors, but was not associated with healthy weight control behaviors. Average daily positive affect was not associated with daily engagement in healthy or unhealthy weight control behaviors., Conclusion: Negative affect was inversely associated with engagement in unhealthy weight control behaviors in this female undergraduate sample. Future studies should continue to elucidate the differences in the relationships in samples of individuals with ED psychopathology vs. healthy samples., (Copyright © 2020. Published by Elsevier Ltd.)

Childhood obesity is a major health concern in the United States (US) and those living in rural communities are at higher risk than their urban counterparts. Few prevention trials have engaged whole families of school-age children in community settings, and none to date have promoted family meals, family activity and healthful home environments in rural settings through a rigorous, randomized controlled trial (RCT). The New Ulm at HOME (NU-HOME) study recruited 114 parent/child dyads in a two-arm (intervention versus wait-list control) RCT to test the efficacy of a family meals-focused program aimed to prevent excess weight gain among 7-10 year-old children in rural Minnesota. The NU-HOME program was adapted from a previously tested program for urban families through a unique community collaboration. The program included 7 monthly in-person sessions for all family members. Parents also participated in 4 motivational goal-setting phone calls. The primary outcome measures were age- and sex-adjusted child body mass index (BMI) z-score, percent body fat, and incidence of overweight and obesity post-intervention. Secondary outcomes included quality of food and beverage availability in the home; family meals and snacks; children's dietary intake quality (e.g., Healthy Eating Index (HEI)-2015, fruits and vegetables, sugar-sweetened beverages, snacks); and children's screen time and weekly minutes of moderate-to-vigorous physical activity, total physical activity, and sedentary behavior. The NU-HOME RCT was a collaborative effort of academic and health system researchers, interventionists and community leaders that aimed to prevent childhood obesity in rural communities through engagement of the whole family in an interactive intervention., (Copyright © 2020. Published by Elsevier Inc.)

Objective: This study is a secondary data analysis that examines the association between parent modelling of dietary intake and physical activity and the same child behaviours among different races/ethnicities using innovative, rigorous and objective measures., Design: Ecological momentary assessment surveys were sent to parents to assess whether their child had seen them exercise or consume food. Dietary recall data and accelerometry were used to determine dietary intake and physical activity behaviours of children., Setting: Participants were randomly selected from primary care clinics, serving low-income and racially/ethnically diverse families in Minnesota, USA., Participants: Participants were families with children aged 5-7 years old who lived with parents 50 % of the time and shared at least one meal together., Results: A 10 percentage point higher prevalence in parent modelling of fruit and vegetable intake was associated with 0·12 higher serving intake of those same foods in children. The prevalence of parent modelling of eating energy dense foods (10 % prevalence units) was associated with 0·09 higher serving intake of sugar-sweetened beverages. Furthermore, accelerometry-measured parent sedentary hours was strongly correlated with child sedentary time (0·37 child sedentary hours per parent sedentary hours). An exploratory interaction analysis did not reveal any statistical evidence that these relationships depended on the child's race/ethnic background., Conclusions: Interventions that increase parent modelling of healthy eating and minimise modelling of energy dense foods may have favourable effects on child dietary quality. Additionally, future research is needed to clarify the associations of parent modelling of physical activity and children's physical activity levels.

Behavioral researchers are increasingly using interactive digital platforms, either as standalone or supplementary intervention tools, to facilitate positive changes in research participants' health habits. Research-oriented interactive websites optimally offer a variety of participatory mediums, such as blogs, user-driven content, or health activities. Owing to the multidirectional features of interactive websites, and a corresponding need to protect research participants' identity and data, it is paramount that researchers design ethical platforms that ensure privacy and minimize loss of anonymity and confidentiality. Authentication (ie, digital verification of one's identity) of interactive sites is one viable solution to these concerns. Although previous publications have addressed ethical requirements related to authenticated platforms, few applied guidelines in the literature facilitate adherence to ethical principles and legally compliant study protocols during all phases of research website creation (feasibility, design, implementation, and maintenance). Notably, to remain compliant with ethical standards and study protocols, behavioral researchers must collaborate with interdisciplinary teams to ensure that the authenticated site remains secure and usable in all stages of the project. In this tutorial, we present a case study conducted at a large research university. Through iterative and practical recommendations, we detail lessons learned from collaborations with the Institutional Review Board, legal experts, and information technology teams. Although the intricacies of our applied tutorial may require adaptations based on each institution's technological capacity, we are confident that the core takeaways are universal and thus useful to behavioral researchers creating ethically responsible and compliant interactive websites., (©Christie L Martin, Eydie N Kramer-Kostecka, Jennifer A Linde, Sarah Friend, Vanessa R Zuroski, Jayne A Fulkerson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.09.2020.)

Daily self-weighing is a weight management behaviour that requires a scale; however, scale ownership may be cost-prohibitive for some patients. Our objective was to understand the proportion of primary care patients with a scale at home, and factors associated with home scale access, to potentially inform future interventions that facilitate scale access. Cross sectional survey of 216 adult patients from three primary care clinics: mixed-income urban/suburban (n = 68); mixed-income urban (n = 70); low-income urban (n = 74). The dependent variable was presence of a home scale; bivariate associations were conducted with variables including demographics, insurance type, clinic setting and self-reported height/weight. Mean age was 53 years; 71% women; 71% racial minority; mean body mass index 32 kg/m 2 . Overall, 56% had a home scale. Most (79%) white patients owned a scale, compared to 46% of racial minority patients (P < .01); 33% of low-income patients owned scale, compared to over 66% of patients at the clinics serving mixed-income populations (P < .01). Most low-income urban clinic patients do not own a home scale. Because self-weighing is an effective weight-management behaviour, clinicians could consider assessing scale access, and future research should assess the health impact of providing scales to patients with overweight/obesity who desire weight loss or maintenance., (© 2020 World Obesity Federation.)

Purpose: The purpose of this research was to generate knowledge of the nutrition-related health disparities and barriers to adequate nutrition and health that transgender and gender-nonconforming (GNC) university students experience. Methods: A needs assessment was conducted with 26 transgender/GNC students enrolled at a large public Midwestern university from November 2017 through February 2018. Interviews and surveys were used to collect qualitative and quantitative data regarding nutrition-related health disparities and barriers, and to identify potential interventions to reduce the disparities or barriers. Results: Major themes emerged around food insecurity, body image, nutrition knowledge and skills, dietary intake, and barriers to healthy eating and positive body image. Other themes included inclusiveness of existing resources and resource needs and preferences. Conclusion: Participants identified interventions that could be introduced on campus to improve their health and nutrition status. Comparisons between study participants and LGBTQ (lesbian, gay, bisexual, transgender, queer) populations in the Midwest and with the general student population at the same university show poorer results for dietary intake, body image behaviors, and food security among transgender/GNC study participants. Overall, this study provides a deeper understanding of nutrition-related needs among transgender/GNC university students., Competing Interests: No competing financial interests exist., (© Sierra R. Kirby and Jennifer A. Linde 2020; Published by Mary Ann Liebert, Inc.)

Background: This analysis helps clarify the individual and joint effects of moderate to vigorous physical activity (MVPA) in concert with significant life events (eg, divorce, marriage, job change or loss, pregnancy, etc) on weight following a behavioral weight loss intervention., Methods: Data from the Tracking Study weight loss trial were utilized to perform a 4-way decomposition of moderation and mediation of life events (≥ 1 vs 0) and MVPA (low <2500 kcal vs high ≥ 2500 kcal) on 24-month weight., Results: The total effect of life events and MVPA on weight was estimated to be 1.63 kg (95% confidence interval = 0.30 to 2.96; P = .02). The controlled direct effect of life events on 24-month weight suggested that experiencing at least one life event controlling for MVPA was associated with an increase of 2.31 kg (95% confidence interval = 0.29 to 4.33) at 24 months. Other interaction and mediation estimates were not statistically significant., Conclusions: This analysis offers new potential for examining health behaviors that may act as both mediators and effect modifiers of health. Although more work is needed to understand the interaction of life events and MVPA on weight loss maintenance, findings help rule out mediation. Life events and MVPA should be considered for their unique effects on weight loss maintenance in the future.

Introduction: Self-weighing is an important component of self-monitoring during weight loss. However, methods of measuring self-weighing frequency need to be validated. This analysis compared self-reported and objective weighing frequency., Methods: Data came from a 24-month randomized controlled trial. Participants received 12 months of a behavioral weight-loss program and were randomly assigned to (1) daily self-weighing, (2) weekly weighing, or (3) no weighing (excluded from analysis). Objective weighing frequency was measured by Wi-Fi enabled scales, and self-reported weighing frequency was assessed every 6 months by questionnaire. Objective weights were categorized to match the scale of the self-report measure., Results: At 12 months, there was 80.8% agreement between self-reported and objective weighing frequency (weighted kappa = 0.67; P < 0.001). At 24 months, agreement decreased to 48.5% (kappa = 0.27; P < 0.001). At both time points in which disagreements occurred, self-reported frequencies were generally greater than objectively assessed weighing. Both self-reported and objectively assessed weighing frequency was associated with weight loss at 12 and 24 months (P < 0.001)., Conclusions: Self-reported weighing frequency is modestly correlated with objective weighing frequency; however, both are associated with weight change over time. Objective assessment of weighing frequency should be used to avoid overestimating actual frequency., (© 2018 The Obesity Society.)

Introduction: Reviewing gaps in self-monitoring during weight loss interventions may help identify individuals demonstrating signs of disengagement in behaviors, including moderate to vigorous physical activity (MVPA), associated with weight loss maintenance. This study examined the associations of different aspects of self-monitoring during a weight loss intervention with 24-month MVPA and weight. Methods: Secondary data analysis from the Tracking Study, a trial comparing weight-tracking frequency during a lifestyle weight loss program, was conducted. Self-monitoring logs from n =339 participants were used to define 4 characteristics and 4 specific gap lengths: short (1-4 weeks), medium (5-8 weeks), long (9-12 weeks), and extra long (>12 weeks). Self-reported MVPA and staff-measured weight were measured at baseline, 6, 12, 18, and 24 months. Generalized estimating equation modeling examined the association between self-monitoring characteristics and reported MVPA and weight. Results: Participants with gaps in self-monitoring as early as the second week of the intervention reported less MVPA and weighed more at 24 months. Furthermore, consistent tracking of MVPA was associated with higher reported MVPA and lower weight. Conclusions: Behavior tracking provides important information about behavioral disengagement early in the intervention process. Future work should test intervention augmentations to improve behavior change when disengagement is detected., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2018 The Author(s).)

Objective: Cross-sectional studies suggest an association between weight cycling and psychological status. Although this is often interpreted as suggesting that weight cycles "cause" psychological distress, the relationship could be bidirectional. This study provides a prospective analysis of the bidirectional association between weight variability and psychological status over an 8-year period in overweight/obese adults with Type 2 diabetes., Method: Data were from the first 8 years of Look AHEAD, a randomized controlled trial comparing health outcomes in individuals with Type 2 diabetes assigned to an intensive lifestyle intervention designed to produce weight loss or a diabetes education and support control group. Psychological status (mental health, depressive symptoms, binge eating) was assessed via surveys and were examined in relation to weight variability at both baseline and year 8. Weight variability was derived from 8 possible annual measurements from participants who had a minimum of 3 consecutive body weight measurements (N = 4,774) and operationalized as the number of year-to-year cycles and the coefficient of variation across all available weight measurements., Results: Controlling for study group, higher baseline scores on mental health (Short Form-36 Mental Component Summary) and lower levels of depressive symptomatology (Beck Depression Inventory) and binge eating (Questionnaire on Eating and Weight Patterns) were associated with significantly less subsequent weight variability. The prospective association between weight variability and psychological status at year 8 was less robust., Conclusions: These results suggest that the cross-sectional relationship between weight variability and psychological status is due primarily to poorer psychological function preceding greater weight instability. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Objective: This study uses a novel mixed methods design to examine the relationship between incidents of teasing in popular television shows and body satisfaction of adolescent viewers., Methods: Survey data were used to identify 25 favorite television shows in a large population-based sample of Minnesota adolescents (N=2793, age=14.4years). Data from content analysis of teasing incidents in popular shows were linked to adolescent survey data. Linear regression models examined associations between exposure to on-screen teasing in adolescents' own favorite shows and their body satisfaction. Effect modification by adolescent weight status was tested using interaction terms., Results: Teasing on TV was common, with 3.3 incidents per episode; over one-quarter of teasing was weight/shape-related. Exposure to weight/shape-related teasing (β=-0.43, p=0.008) and teasing with overweight targets (β=-0.03, p=0.02) was inversely associated with girls' body satisfaction; no associations were found for boys. Findings were similar regardless of the adolescent viewer's weight status., Conclusions: Families, health care providers, media literacy programs and the entertainment industry are encouraged to consider the negative effects exposure to weight stigmatization can have on adolescent girls., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: Previous research has demonstrated that television has the potential to influence youth behaviors, but little evidence exists on how television depicts physical activity (PA), an important public health priority for youth. This mixed-methods study investigated depictions of television characters' participation in PA in the top 25 favorite shows ranked by a diverse sample of 2,793 adolescents., Method: Randomly selected episodes from each show were content-analyzed for PA incidents, reasons, and context and in relation to the gender and weight status of participating characters., Results: A total of 374 incidents of PA were coded across 75 episodes, with an average of 5.0 incidents per episode. Although male and female characters were equally likely to engage in at least 1 incident of PA, male characters were involved in a statistically significantly larger proportion of PA incidents than were female characters, and they were more likely to engage in PA for competitive sport. There was no statistically significant difference in engagement in PA or the proportion of PA incidents for characters coded as overweight compared with nonoverweight characters., Conclusions: Although female characters tended to be underrepresented in PA, this study reveals positive messages for how gender and weight are portrayed in relation to PA on TV.

Introduction: The young adult years have been recognized as an influential period for excess weight gain. Non-traditional students and those attending 2-year community colleges are at particularly high risk for a range of adverse weight-related outcomes., Design: Choosing Healthy Options in College Environments and Settings was an RCT with students randomly assigned into a control or intervention condition after baseline assessment. The study was designed to evaluate if a 24-month weight-gain prevention intervention reduces the expected increase in BMI and overweight prevalence in young adults attending 2-year colleges. Two cohorts were recruited, corresponding to the fall and spring semesters. Data collection occurred at four time points for each cohort, with baseline occurring in fall 2011 for Cohort 1 and spring 2012 for Cohort 2. The 24-month follow-up occurred in fall 2013 for Cohort 1 and spring 2014 for Cohort 2. Data analysis occurred in 2015-2016., Setting/participants: This research was conducted with 441 students from three community colleges in Minnesota., Intervention: The 24-month intervention began with a 1-credit college course on healthy weight behaviors. A social networking and social support website was introduced as part of the course and participation encouraged for the duration of the trial., Main Outcome Measures: Changes in BMI, weight, body fat percentage, waist circumference, and weight status were assessed., Results: Retention of the cohorts at 24 months was 83.4%. There was not a statistically significant difference in BMI between conditions at the end of the trial. However, there was a statically significant difference in the prevalence of overweight/obesity between treatment conditions at 24 months. Also, participants randomized to the intervention who were overweight or obese at baseline were more than three times as likely to transition to a healthy weight by the end of the trial as compared with control students., Conclusions: The intervention was not successful in achieving BMI differences between treatment groups. However, an 8% reduction in the prevalence of overweight and obesity over time may have population-level significance., Trial Registration: This study is registered at www.clinicaltrials.gov NCT01134783., (Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Our objective was to conduct a process evaluation of the CHOICES (Choosing Healthy Options in College Environments and Settings) study, a large, randomized, controlled trial designed to prevent unhealthy weight gain in young adults (aged 18-35) attending 2-year community colleges in the USA. The 24-month intervention consisted of participation in an academic course and a social networking and support website. Among intervention participants, completion rates for most course activities were >80%, reflecting a high level of dose received. Course retention and participant satisfaction were also high. Engagement results, however, were mixed with less than half of participants in the online and hybrid sections of the course reporting that they interacted with course materials ≥3 h/week, but 50-75% reporting that they completed required lessons 'all/very thoroughly'. Engagement in the website activities was also mixed with more than half of intervention participants logging onto the website during the first month, but then declining to 25-40% during the following 23 months of the intervention. Intervention engagement is a challenge of online interventions and a challenge of working with the young adult age group in general. Additional research is needed to explore strategies to support engagement among this population, particularly for relatively long intervention durations., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: To describe the frequency of self-weighing and reactions to prescribed weekly weighing among individuals with eating disorder (ED) diagnoses, and to compare individuals weighing more or less frequently on mass index (BMI) and the Eating Disorder Examination (EDE) subscales., Method: Baseline EDE and demographics from five studies (N = 758)., Results: Self-weighing was most frequent among individuals with anorexia nervosa (AN), followed by those with bulimia nervosa (BN) and binge eating disorder (BED). On average, participants reacted moderately negative to prescribed weekly weighing. No relationship between weighing frequency and BMI was evident in any sample. There was indication of greater pathology (i.e., restraint, shape concern, weight concern, global) in AN with more frequent weighing. In BN, mixed evidence emerged to support a relationship between more frequent weighing and higher shape concern, weight concern, and global score. In BED, higher restraint was found in those who weighed versus those who did not., Discussion: Weighing frequency in each eating disorder (ED) sample was to some extent associated with greater ED severity, but not BMI. Future research should examine relationships between self-weighing, reactions to changing weighing frequency, and ED symptomatology in both ED and non-ED groups to understand the impact of self-weighing in heterogeneous populations. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:817-821)., (© 2016 Wiley Periodicals, Inc.)

Excess weight gain tends to occur in young adulthood. However, research examining effective weight-related interventions for this age group has been limited. As one of seven trials in the EARLY Trials consortium (Early Adult Reduction of weight through LifestYle intervention), the CHOICES Study (Choosing Healthy Options in College Environments and Settings) tested effects of a technology-integrated, young adult weight gain prevention intervention. It was a randomized controlled trial with assessments at baseline (2011) and 4-, 12- and 24-months post-intervention initiation and included 441 participants (ages 18-35) who were students at three Minnesota community colleges. The 24-month intervention included a 1-credit academic course and social networking and support online intervention. This analysis examined effects on 12 secondary behavioral outcomes across three domains: diet (fast food, sugary beverages, breakfast, at-home meal preparation), physical activity/screen time (minutes and energy expenditure in leisure time physical activity, television viewing, leisure time computer use) and sleep (hours of sleep, time required to fall asleep, days not getting enough rest, difficulty staying awake). The intervention resulted in significant reductions in fast food (p=0.007) but increases in difficulty staying awake (p=0.015). There was limited evidence of other behavior changes at 4months (0.05

Background/aims: Young adults are at risk of weight gain, but little is known about designing effective weight control trials for young adults or how to recruit and retain participants in these programs. The Choosing Healthy Options in College Environments and Settings (CHOICES) study evaluated the effectiveness of a weight gain prevention intervention for 2-year college students. We describe the methods used to recruit and retain the colleges and their students, describe the sample and discuss recommendations for future studies., Methods: Students were recruited into a 24-month trial of a weight control intervention with assessment periods at baseline, 4-, 12- and 24-month follow-up., Results: We successfully recruited 441 students through partnerships with three 2-year colleges through a variety of campus-based methods. Ultimately, 83.4% of the randomized cohort participated in the 24-month assessment period. Those retained more often were White (p = 0.03) compared to those who dropped out or were lost to follow-up; no other socio-demographic factor (e.g. gender, ethnicity and education), body mass index, body fat, waist circumference or weight status was observed to differ between randomly assigned groups., Conclusion: Two-year colleges and their students are interested in participating in weight-related trials and partnering with universities for research. Researchers must work closely with administrators to identify benefits to their institutions and to resolve student-level barriers to recruitment and retention. Our experiences from the Choosing Healthy Options in College Environments and Settings study should be useful in identifying effective recruitment and retention methods for weight gain prevention trials among young adults., (© The Author(s) 2015.)

Objective: To describe the prevalence of self-weighing in the transition period from adolescence to young adulthood and examine cross-sectional and longitudinal associations between self-weighing and weight status, psychological, and behavioral outcomes., Design: Project Eating and Activity in Teens and Young Adults, a longitudinal cohort study that assessed variables 3 times over 10 years., Participants: A total of 1,868 adolescents and young adults., Main Outcome Measures: Weight, body mass index, weight disparity, body satisfaction, weight concern, self-esteem, depression, and unhealthy weight control behaviors., Analysis: Cross-sectional and longitudinal., Results: Significant positive correlations were found at each time point between self-weighing and weight concern for both genders. Self-weighing was significantly inversely related to self-esteem at each time point in female participants. Increases in endorsement of self-weighing were significantly related to decreases in body satisfaction and self-esteem and increases in weight concern and depression in female participants and to increases in weight concern in male participants., Conclusions and Implications: Findings suggest that self-weighing may not be an innocuous behavior for young people, particularly women. Interventions should assess potential harmful consequences of self-weighing in addition to any potential benefits. It may be appropriate for clinicians to ask about self-weighing, and if it is frequent, to explore motivations, perceived benefits, and potential adverse correlates or consequences., (Published by Elsevier Inc.)

Background: Observational evidence from behavioral weight control trials and community studies suggests that greater frequency of weighing oneself, or tracking weight, is associated with better weight outcomes. Conversely, it has also been suggested that frequent weight tracking may have a negative impact on mental health and outcomes during weight loss, but there are minimal experimental data that address this concern in the context of an active weight loss program. To achieve the long-term goal of strengthening behavioral weight loss programs, the purpose of this randomized controlled trial (the Tracking Study) is to test variations on frequency of self-weighing during a behavioral weight loss program, and to examine psychosocial and mental health correlates of weight tracking and weight loss outcomes. This paper describes the study design, intervention features, recruitment, and baseline characteristics of participants enrolled in the Tracking Study., Methods/design: Three hundred thirty-nine overweight and obese adults were recruited and randomized to one of three variations on weight tracking frequency during a 12-month weight loss program with a 12-month follow-up: daily weight tracking, weekly weight tracking, or no weight tracking. The primary outcome is weight in kilograms at 24 months. The weight loss program integrates each weight tracking instruction with standard behavioral weight loss techniques (goal setting, self-monitoring, stimulus control, dietary and physical activity enhancements, lifestyle modifications); participants in weight tracking conditions were provided with wireless Internet technology (wi-fi-enabled digital scales and touchscreen personal devices) to facilitate weight tracking during the study., Conclusion: This study was successful in recruiting adult male and female participants and is positioned to enhance the standard of care with regard to weight tracking recommendations., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Unlabelled: OBJECTIVES AND PARTICIPANTS: The purpose of this article is to describe weight indicators and weight-related behaviors of students enrolled in 2-year colleges, including sex differences., Methods: During Fall 2011 and Spring 2012, 441 students from 3 Minnesota community colleges enrolled in the Choosing Healthy Options in College Environments and Settings (CHOICES) Study and completed baseline assessments. Participants completed a baseline survey evaluating eating and activity patterns, sleep, and stress and measures of height, weight, waist circumference, and body fat., Results: Participants were primarily female (68%), white (73%), with a mean age of 22.8 years, and 66.2% reporting an annual income < $12,000. Almost half (47%) were overweight or obese. Young males appeared to engage the most in risky health behaviors and had higher levels of overweight or obesity, compared with young females., Conclusions: Findings confirm the need for innovative interventions targeting this understudied and underserved young adult population.

Objective: Self-weighing frequency is associated with lower body weight and less weight gain. This study describes self-weighing frequency in two samples of working adults from different fields: office-based and transit employees., Methods: Self-weighing frequency and demographic information were self-reported at baseline measurement of two worksite interventions. Data were collected from transit employees (n= 1479) enrolled in a worksite intervention between October and December of 2005 and office based employees (n=1747) in another worksite intervention between January 2006 and April 2007 in the Minneapolis, MN and St. Paul, MN metropolitan area. Trained staff measured height and weight. Multinomial logistic regression models examined associations between self-weighing frequency and body mass index, study sample, and gender adjusting for age, race, and education., Results: Odds ratios showed self-weighing frequency was significantly different between overweight and obese categories and between study samples. Office-based employees self-weighed more frequently than transit employees. Overweight employees self-weighed more frequently than obese employees., Conclusion: While self-weighing outcomes and associations with obesity prevention and weight loss are still under investigation, these results may help in improving obesity intervention planning and informing worksite weight management programs by identifying how often working adults naturally engage in this behavior prior to weight loss interventions.

Young adults are at risk for weight gain in the transition to independent adulthood; 2-year college students are at greater risk and understudied relative to 4-year students. This project conducted formative research for a randomized controlled weight gain prevention trial among 2-year college students, to ensure appropriateness of content and delivery of a curriculum originally developed for 4-year college students. Data were collected from community college students, faculty, and staff from October 2009 to August 2011. Work included focus groups and key informant interviews, curriculum pilot testing, and social network and support website beta testing. Based on focus groups and interviews, program content, course delivery modes, and communication channels were adjusted to meet population interests and preferences. The course was delivered successfully in pilot testing, and the website was received well by beta testers. Formative work successfully guided program adaptations to address population needs.

Background: Young adults are at risk for weight gain. Little is known about how to design weight control programs to meet the needs of young adults and few theory-based interventions have been evaluated in a randomized control trial. The Choosing Healthy Options in College Environments and Settings (CHOICES) study was funded to create a technology-based program for 2-year community college students to help prevent unhealthy weight gain. The purpose of this paper is to: 1) provide a brief background on weight-related interventions in young adults; 2) describe the study design for the CHOICES study, the conceptual model guiding the research and the CHOICES intervention; and 3) discuss implications of this research for health educators., Translation to Health Education Practice: Our experiences from the CHOICES study will be useful in suggesting other theory-based models and intervention strategies that might be helpful in programs attempting to prevent unhealthy weight gain in young adults. In addition, this paper discusses important considerations for working with 2-year colleges on this type of health promotion work.

Environmental modifications have been shown to increase short-term stair use, longer-term success is unclear. This study assessed the 2-year effectiveness of an environmental intervention promoting worksite stair use. We assessed stair use at work by means of self-reports and infrared beam counters (which send a safe and invisible beam of infrared light from one side of a stairwell to a reflector on the other side; when an individual uses the stairs, the infrared beam is disrupted and an instance of stair use is recorded) at six worksites (three intervention, three control) in a group randomized, controlled worksite weight-gain prevention trial in Minneapolis/St. Paul, MN. Intervention modifications were signs encouraging stair use, music, and art posters in stairwells. We collected data before environmental modifications (2006-2007) and at the end of the 2-year intervention (2008-2009). The intervention had a significant positive effect on stair use measured both objectively and via self-report, with greatest increases reported among those participants who used the stairs least at baseline. Following 2-years of continuously-maintained stairwell modifications, increases in both objectively-measured and self-reported stair use were significantly larger at intervention than control worksites. Study findings suggest that the positive impact of environmental modifications on stair use persist over a longer time period than has been previously demonstrated. Results also indicate that infrequent stair users may be most amenable to the behavior changes encouraged by these environmental enhancements.

The Schedule for Nonadaptive and Adaptive Personality-Youth Version (SNAP-Y) is a new, reliable self-report questionnaire that assesses 15 personality traits relevant to both normal-range personality and the alternative DSM-5 model for personality disorder. Community adolescents, 12 to 18 years old (N = 364), completed the SNAP-Y; 347 also completed the Big Five Inventory-Adolescent, 144 provided 2-week retest data, and 128 others completed the Minnesota Multiphasic Personality Inventory-Adolescent. Outpatient adolescents (N = 103) completed the SNAP-Y, and 97 also completed the Minnesota Multiphasic Personality Inventory-Adolescent. The SNAP-Y demonstrated strong psychometric properties, and structural, convergent, discriminant, and external validities. Consistent with the continuity of personality, results paralleled those in adult and college samples using the adult Schedule for Nonadaptive and Adaptive Personality-Second Edition (SNAP-2), from which the SNAP-Y derives and which has established validity in personality-trait assessment across the normal-abnormal continuum. The SNAP-Y thus provides a new, clinically useful instrument to assess personality traits and personality pathology in adolescents.

Purpose: To examine the relationships between self-weighing frequency, and weight-related behaviors and psychological well-being in a population-based sample of adolescents., Methods: This study compared weight-related behaviors between infrequent and frequent self-weighers, stratified by weight status and gender. Data were from Project EAT 2010 (Eating and Activity in Teens), a population-based study of 2,778 adolescents., Results: Approximately 14% of girls and boys weighed themselves frequently (weekly or more). In comparison to girls who were infrequent self-weighers, girls who were frequent self-weighers were more likely to diet, engage in unhealthy and extreme weight control behaviors, use unhealthy muscle-enhancing behaviors, and have lower self-esteem and greater body dissatisfaction. In comparison to boys who were infrequent self-weighers, boys who were frequent self-weighers were more likely to diet, engage in unhealthy and extreme weight control behaviors, use unhealthy muscle-enhancing behaviors, and report greater depressive symptoms. Among overweight adolescents, in addition to being associated with these harmful outcomes, frequent self-weighing was associated with the use of healthy weight control behaviors and with higher levels of moderate-to-vigorous activity., Conclusions: Findings indicate that adolescents who frequently self-weigh themselves are at increased risk for a number of problematic health behaviors and poorer psychological outcomes. For overweight adolescents, frequent self-weighing was additionally associated with a number of positive outcomes. Based upon these findings, any recommendations for weight monitoring should be made cautiously; all adolescents, including overweight adolescents, should be advised not to engage in frequent self-weighing behaviors. Furthermore, any adolescents engaging in frequent self-weighing behaviors should be monitored for problematic outcomes., (Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: This article describes the effectiveness of goal setting instruction in the CHOICES (Choosing Healthy Options in College Environments and Settings) study, an intervention evaluating the effectiveness of weight gain prevention strategies for 2-year college students., Methods: Four hundred and forty-one participants from three community colleges were recruited. Participants randomized into the intervention (n=224) enrolled in a course that taught strategies to help maintain or achieve a healthy weight. Participants were instructed in SMART (Specific, Measurable, Attainable, Realistic, Time-based) and behavioral goal-setting practices. Throughout the course, participants set goals related to improving their sleep, stress-management, exercise, and nutrition.", Results: Intervention participants set four hundred eighteen goals. Each goal was carefully evaluated. The efforts to teach behavioral goal-setting strategies were largely successful; however efforts to convey the intricacies of SMART goal-setting were not as successful., Conclusions: Implications for effective teaching of skills in setting SMART behavioral goals were realized in this study. The insights gained from the goal-setting activities of this study could be used to guide educators who utilize goals to achieve health behavior change., Recommendations: Based on the results of this study, it is recommended that very clear and directed instruction be provided in addition to multiple opportunities for goal-setting practice. Implications for future interventions involving education about goal-setting activities are discussed.

Background: Little is known about the association between self-weighing frequency and weight gain prevention, particularly in worksite populations., Purpose: The degree to which self-weighing frequency predicted 2-year body weight change in working adults was examined., Method: The association between self-weighing frequency (monthly or less, weekly, daily, or more) and 24-month weight change was analyzed in a prospective cohort analysis (n = 1,222) as part of the larger HealthWorks trial., Results: There was a significant interaction between follow-up self-weighing frequency and baseline body mass index. The difference in weight change ranged from -4.4 ± 0.8 kg weight loss among obese daily self-weighers to 2.1 ± 0.4 kg weight gain for participants at a healthy weight who reported monthly self-weighing., Conclusion: More frequent self-weighing seemed to be most beneficial for obese individuals. These findings may aid in the refinement of self-weighing frequency recommendations used in the context of weight management interventions.

Background: Some evidence suggests that physical activity programs mainly attract employees who are already active. This study examined the degree to which baseline physical activity was associated with enrollment in worksite walking clubs., Methods: All variables were measured at baseline. Walking club participation was measured over 2 years. There were 642 individuals from 3 worksites with complete data available for logistic regression analyses., Results: Baseline physical activity [OR (95% CI)=1.00 (0.99, 1.01)] was not a significant predictor of walking club participation. Participants who were older [OR=1.03 (1.01, 1.04)] or indicated more social support for physical activity [OR=1.13 (1.02, 1.25)] had significantly higher odds of participation relative to those who were younger or indicated less social support, respectively. In addition, men [OR=-0.25 (0.18, 0.36)] and employees from the second worksite [OR=-0.41 (0.25, 0.67)] had significantly lower odds of participation relative to women and employees from the first or third worksites, respectively. Sensitivity analyses arrived at similar conclusions., Conclusions: Worksite walking clubs were appealing across varying levels of physical activity. Future research should improve marketing and program design to engage harder-to-reach segments of the workforce, particularly young men and those with limited social support.

Background: Obesity and depression are closely linked, and each has been associated with disability. However, few studies have assessed inter-relationships between these conditions., Design and Methods: In this study, 4641 women aged 40-65 completed a structured telephone interview including self-reported height and weight, the Patient Health Questionnaire (PHQ) assessment of depression, and the World Health Organization Disability Assessment Schedule II (WHODAS II). The survey response rate was 62%. We used multivariable regression models to assess relationships between obesity, depression, and disability., Results: The mean age was 52 years; 82% were White; and 80% were currently employed. One percent were underweight, 39% normal weight, 27% overweight, and 34% obese. Mild depressive symptoms were present in 23% and moderate-to-severe symptoms were present in 13%. After multivariable adjustment, depression was a strong independent predictor of worse disability in all 7 domains (cognition, mobility, self-care, social interaction, role functioning, household, and work), but obesity was only a significant predictor of greater mobility, role-functioning, household, and work limitations (P < 0.05) (overweight was not significantly associated with any disability domain). Overall, the effect on disability was stronger and more pervasive for depression than obesity, and there was no significant interaction between the two conditions (P > 0.05). Overweight and obesity were associated with 5760 days of absenteeism per 1000 person-years, and depression was associated with 18,240 days of absenteeism per 1000 person-years., Conclusions: The strong relationships between depression, obesity and disability suggest that these conditions should be routinely screened and treated among middle-aged women., (© 2012 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. All rights reserved.)

BACKGROUND: Obesity and depression are closely linked, and each has been associated with disability. However, few studies have assessed inter-relationships between these conditions. DESIGN AND METHODS: In this study, 4 641 women aged 40-65 completed a structured telephone interview including self-reported height and weight, the Patient Health Questionnaire (PHQ) assessment of depression, and the World Health Organization Disability Assessment Schedule II (WHODAS II). The survey response rate was 62%. We used multivariable regression models to assess relationships between obesity, depression, and disability. RESULTS: The mean age was 52 years; 82% were white; and 80% were currently employed. One percent were underweight, 39% normal weight, 27% overweight, and 34% obese. Mild depressive symptoms were present in 23% and moderate-to-severe symptoms were present in 13%. After multivariable adjustment, depression was a strong independent predictor of worse disability in all 7 domains (cognition, mobility, self-care, social interaction, role functioning, household, and work), but obesity was only a significant predictor of greater mobility, role-functioning, household, and work limitations (P<0.05) (overweight was not significantly associated with any disability domain). Overall, the effect on disability was stronger and more pervasive for depression than obesity, and there was no significant interaction between the two conditions (P>0.05). Overweight and obesity were associated with 5 760 days of absenteeism per 1 000 person-years, and depression was associated with 18 240 days of absenteeism per 1 000 person-years. CONCLUSIONS: The strong relationships between depression, obesity and disability suggest that these conditions should be routinely screened and treated among middle-aged women.

Background: U.S. adults are at unprecedented risk of becoming overweight or obese, and most scientists believe the primary cause is an obesogenic environment. Worksites provide an opportunity to shape the environments of adults to reduce obesity risk. The goal of this group-randomized trial was to implement a four-component environmental intervention at the worksite level to positively influence weight gain among employees over a two-year period. Environmental components focused on food availability and price, physical activity promotion, scale access, and media enhancements., Methods: Six worksites in a U.S. metropolitan area were recruited and randomized in pairs at the worksite level to either a two-year intervention or a no-contact control. Evaluations at baseline and two years included: 1) measured height and weight; 2) online surveys of individual dietary intake and physical activity behaviors; and 3) detailed worksite environment assessment., Results: Mean participant age was 42.9 years (range 18-75), 62.6% were women, 68.5% were married or cohabiting, 88.6% were white, 2.1% Hispanic. Mean baseline BMI was 28.5 kg/m(2) (range 16.9-61.2 kg/m(2)). A majority of intervention components were successfully implemented. However, there were no differences between sites in the key outcome of weight change over the two-year study period (p = .36)., Conclusions: Body mass was not significantly affected by environmental changes implemented for the trial. Results raise questions about whether environmental change at worksites is sufficient for population weight gain prevention., Trial Registration: ClinicalTrials.gov: NCT00708461.

Objective: Little is known about the relationship between weight change and workplace absenteeism. The purpose of this study was to examine the degree to which weight change predicted 2-year absenteeism., Methods: A longitudinal analysis of 1,228 employees enrolled in a worksite-randomized controlled trial was performed. Participants were all working adults in the Minneapolis, MN, area (USA)., Results: The final model indicated a significant interaction between weight change and baseline BMI. The difference in absenteeism ranged from (mean ± SE) 3.2 ± 1.2 days among healthy weight employees who maintained their weight to 6.6 ± 1.1 days among obese employees who gained weight (and slightly higher among healthy weight employees who lost weight). The adjusted model also indicated that participants who were male, not depressed, nonsmokers, and had lower baseline absenteeism had significantly less workplace absenteeism relative to participants who were female, depressed, smokers, and had higher baseline absenteeism., Conclusion: Absenteeism was generally low in this sample, but healthy weight employees who maintained their body weight over 2 years had the fewest number of sick days. More research is needed in this area, but future workforce attendance interventions may be improved by focusing on the primary prevention of weight gain in healthy weight employees., (Copyright © 2012 S. Karger GmbH, Freiburg.)

Background: Both obesity and depression have been associated with significant increases in health care costs. Previous research has not examined whether cost increases associated with obesity could be explained by confounding effects of depression., Objective: Examine whether the association between obesity and health care costs is explained by co-occurring depression., Design: Cross-sectional study including telephone survey and linkage to health plan records., Participants: 4462 women aged 40 to 65 enrolled in prepaid health plan in the Pacific Northwest., Main Measures: The telephone survey included self-report of height and weight and measurement of depression by the Patient Health Questionnaire (PHQ9). Survey data were linked to health plan cost accounting records., Key Results: Compared to women with BMI less than 25, proportional increases in health care costs were 65% (95% CI 41% to 93%) for women with BMI 30 to 35 and 157% (95% CI 91% to 246%) for women with BMI of 35 or more. Adjustment for co-occurring symptoms of depression reduced these proportional differences to 40% (95% CI 18% to 66%) and 87% (95% CI 42% to 147%), respectively. Cost increases associated with obesity were spread across all major categories of health services (primary care visits, outpatient prescriptions, inpatient medical services, and specialty mental health care)., Conclusions: Among middle-aged women, both obesity and depression are independently associated with substantially higher health care costs. These cost increases are spread across the full range of outpatient and inpatient health services. Given the high prevalence of obesity, cost increases of this magnitude have major policy and public health importance.

Clinical obesity treatments are of limited reach. Self-directed weight control attempts are common, but little attention has been given to providing guidance for such efforts in the population. The present research tests a brief intervention approach to weight control. Pilot data were collected from 66 University of Minnesota employees (72.7% women, 81.8% white) randomized to an assessment-only control condition or a single intervention session to teach empirically valid self-directed weight-control methods. Mean baseline weight was 87.1 kilograms (range 64.0-120.3 kilograms). Though statistically nonsignificant, intervention participants averaged greater weight loss by 6 months than controls (-.80 kilograms vs. -.19 kilograms), F(1, 44)=.47, p=.50, Cohen's d=.21. There was a significant group×time interaction for self-weighing frequency, F(2, 41)=10.84, p<.001. With some enhancement and more attention to dissemination, a brief self-directed program has potential as a useful approach to population weight-gain prevention.

Background: Obesity is associated with clinical depression among women. However, depressed women are often excluded from weight loss trials., Purpose: This study examined treatment outcomes among women with comorbid obesity and depression., Methods: Two hundred three (203) women were randomized to behavioral weight loss (n = 102) or behavioral weight loss combined with cognitive-behavioral depression management (n = 101)., Results: Average participant age was 52 years; mean baseline body mass index was 39 kg/m(2). Mean Patient Health Questionnaire and Hopkins Symptom Checklist (SCL-20) scores indicated moderate to severe baseline depression. Weight loss and SCL-20 changes did not differ between groups at 6 or 12 months in intent-to-treat analyses (p = 0.26 and 0.55 for weight, p = 0.70 and 0.25 for depressive symptoms)., Conclusions: Depressed obese women lost weight and demonstrated improved mood in both treatment programs. Future weight loss trials are encouraged to enroll depressed women.

Limited evidence suggests that depression is associated with poorer outcomes in behavioral weight loss programs; however, people with major depression are typically excluded from weight loss intervention trials. This study examined the effect of depression on women's participation and weight loss in behavioral treatment. Non-treatment seeking obese women over 40 years of age with major depressive disorder (MDD, n = 65) and without MDD (n = 125) were recruited into a 26-session group intervention. Primary analyses compared participants' mean weight change from baseline to 6 and 12 months; at 6 months, women with MDD lost a mean of 3.8 kg vs 4.3 kg for women without MDD (t = 0.54, p = .59). At 12 months, women with MDD lost 3.0 kg and women without MDD lost 3.6 kg (t = 0.44, p =.66). Women who attended at least 12 treatment sessions lost more weight than women who attended fewer sessions, regardless of depression status (ie, there was no significant interaction between depression and session attendance). Results suggest that depression should not be an exclusion criterion for weight loss intervention programs.

Objective: To examine the association between improvement in depression and loss of weight among women with depressive symptoms entering a behavioral weight loss program., Methods: Women aged 40 to 65 with body mass index (BMI) of 30 or more and co-occurring symptoms of depression were identified by a population-based survey. A total of 203 of these women were enrolled in one of two behavioral treatment programs: one focused on weight loss and another on both weight loss and depression. Both programs included up to 26 group sessions over 12 months. Assessments at baseline, 6 months, 12 months and 24 months included measurement of weight, depressive symptoms, self-reported physical activity and estimated caloric intake (via food frequency questionnaire)., Results: Over the first 6 months, women with a decrease in depression score were more likely to lose 5 kg or more than women without a significant decrease in depression (38% vs. 22%, odds ratio=2.20, 95% CI=1.09 to 4.44). Over the same period, improvement in depression was associated with increase in physical activity but not with change in caloric intake. Change in depression and change in weight were not significantly associated over later intervals (between 6 and 12 months or between 12 and 24 months)., Conclusions: Among women with co-occurring obesity and depression, short-term improvement in depression is associated with weight loss., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Data from a trial of a 26-session structured group behavioral weight loss intervention were used to examine how group attendance, weight loss, and changes in depression clustered within therapy groups. Participants were recruited via a population-based survey of female health plan members aged 40 to 65. The sample included 143 women attending 13 therapy groups. Average number of sessions attended was 15.9 (st. dev. 7.2) and average weight loss over 12 months was 4.24 kg (st. dev. 7.79 kg). In hierarchical (random effects) linear models predicting attendance and weight loss, attendance did cluster significantly within therapy groups (F=2.83, df=12, p=.002; ICC = .14) but weight loss (F=0.89, df=12, p=.56; ICC = .00) and change in depressive symptoms (F=0.25, df=12, p=.99; ICC = .00) did not. Accounting for baseline characteristics of group participants had no significant effect on these findings. Relatively small average weight loss in this sample may have limited our ability to detect clustering of weight loss within groups. We conclude that clinicians should consider addressing the effects of drop-out on other group members and that researchers should consider the impact of clustering in analyses of data regarding group treatments.

Summary: Data from a trial of a 26-session structured group behavioral weight loss intervention were used to examine how group attendance, weight loss, and changes in depression clustered within therapy groups. Participants were recruited via a population-based survey of female health plan members aged 40-65. The sample included 143 women attending 13 therapy groups. Average number of sessions attended was 15.9 (S.D. 7.2) and average weight loss over 12 months was 4.24 kg (S.D. 7.79 kg). In hierarchical (random effects) linear models predicting attendance and weight loss, attendance did cluster significantly within therapy groups (F = 2.83, df = 12, p = .002; ICC = .14) but weight loss (F = 0.89, df = 12, p = .56; ICC = .00) and change in depressive symptoms (F = 0.25, df = 12, p = .99; ICC = .00) did not. Accounting for baseline characteristics of group participants had no significant effect on these findings. Relatively small average weight loss in this sample may have limited our ability to detect clustering of weight loss within groups. We conclude that clinicians should consider addressing the effects of drop-out on other group members and that researchers should consider the impact of clustering in analyses of data regarding group treatments.:, (© 2010 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. All rights reserved.)

Background: Obesity and depression may each be associated with lower rates of cervical and breast cancer screening. Studies have examined obesity or depression alone, but not together, despite the established link between them., Purpose: This article aims to disentangle the effects of depression and obesity on receipt of breast and cervical cancer screening., Methods: A stratified sampling design was used to recruit women aged 40-65 years with information on BMI from an integrated health plan in Washington State in 2003-2005. A telephone survey included the Patient Health Questionnaire-9 for depression, weight, and height. Automated data assessed Paps for 3097 women over a 3-year period and screening mammograms over a 2-year period for 2163 women aged > or =51 years. Logistic regression models (conducted in 2008) examined the association between obesity and depression and receipt of screening tests., Results: In univariate logistic regression models, women were less likely to receive a Pap if they were obese (OR=0.53, 95% CI=0.41, 0.69) or depressed (OR=0.60, 95% CI=0.42, 0.87). Further, women were less likely to receive a screening mammogram if they were depressed (OR=0.45, 95% CI=0.30, 0.67). In multivariable models, only obesity remained significantly associated with a lower likelihood of Pap screening (OR=0.67, 95% CI=0.0.49, 0.93), and only depression remained significantly associated with lower rates of screening mammography (OR=0.49, 95% CI=0.31, 0.76). Obesity and depression did not interact significantly in either model., Conclusions: Obesity and depression appear to have specific effects on receipt of different cancer-screening tests., (Copyright (c) 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to explore how weight might influence the relationship between depression and smoking., Methods: Data were obtained from a cross-sectional survey representative of women age 40-65 enrolled in Group Health Cooperative, a health plan serving members in Washington and northern Idaho (n=4640). We examined the relationships between depression and smoking in normal weight, overweight, and obese women using weighted multiple logistic regression with both minimal and full adjustment., Results: Current depression was significantly associated with current smoking in obese women (adjusted odds ratio=2.48, 95% confidence interval=1.26-4.88) but not in underweight/normal or overweight women. Among ever smokers, obese women, but not other groups, were significantly less likely to have quit smoking in the past., Conclusions: In our preliminary study, the association between smoking and depression in middle-aged women appears to be limited to the obese subset and may stem from a lesser likelihood of obese ever smokers to have quit. This population represents an important target for preventive medicine efforts.