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Extended-care interventions have been demonstrated to improve maintenance of weight loss after the end of initial obesity treatment; however, it is unclear whether these programs are similarly effective for African American versus White participants. The current study examined differences in effectiveness of individual versus group telephone-based extended-care on weight regain, compared to educational control, in 410 African American (n = 82) and White (n = 328) adults with obesity (mean ± SD age = 55.6 ± 10.3 years, BMI = 36.4 ± 3.7 kg/m2). After controlling for initial weight loss, multivariate linear models demonstrated a significant interaction between treatment condition and race, p =.048. Randomization to the individual telephone condition produced the least amount of weight regain in White participants, while the group condition produced the least amount of weight regain in African American participants. Future research should investigate the role of social support in regain for African American versus White participants and examine whether tailoring delivery format by race may improve long-term outcomes. [ABSTRACT FROM AUTHOR]

This study examined whether specific participant characteristics (age, sex, BMI, exercise history, and self-efficacy) differentially predicted adherence to exercise programs of moderate vs. higher levels of intensity and frequency. Sedentary adults (N = 379) were randomly assigned in a 2 x 2 design to walk 30 min/day at a frequency of either 3 to 4 days/week or 5 to 7 days/week, at an intensity of either 45-55% or 65-75% of maximum heart rate reserve. Exercise adherence was assessed via daily exercise logs completed during Months 2-6 of the exercise program. The major finding of this study was that participants with higher levels of past exercise showed better adherence to higher intensity exercise but tended to have poorer adherence to moderate intensity exercise. Our results suggest that a person's previous experience with exercise should be considered when prescribing higher intensity exercise, and that individuals with an extensive exercise history can be prescribed higher intensity exercise. [ABSTRACT FROM AUTHOR]

Abstract Obesity is a major contributor to the greater prevalence of chronic disease morbidity and mortality observed in rural versus nonrural areas of the U.S. Nonetheless, little research attention has been given to modifying this important driver of rural/urban disparities in health outcomes. Although lifestyle treatments produce weight reductions of sufficient magnitude to improve health, the existing research is limited with respect to the long-term maintenance of treatment effects and the dissemination of services to underserved populations. Recent studies have demonstrated the feasibility of delivering lifestyle programs through the infrastructure of the U.S. Cooperative Extension Service (CES), which has >2900 offices nationwide and whose mission includes nutrition education and health promotion. In addition, several randomized trials have shown that supplementing lifestyle treatment with extended-care programs consisting of either face-to-face sessions or individual telephone counseling can improve the maintenance of weight loss. However, both options entail relatively high costs that inhibit adoption in rural communities. The delivery of extended care via group-based telephone intervention may represent a promising, cost-effective alternative that is well suited to rural residents who tend to be isolated, have heightened concerns about privacy, and report lower quality of life. The Rural Lifestyle Eating and Activity Program (Rural LEAP) is a randomized trial, conducted via CES offices in rural communities, targeted to adults with obesity (n = 528), and designed to evaluate the effectiveness and cost-effectiveness of extended-care programs delivered via group or individual telephone counseling compared to an education control condition on long-term changes in body weight. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the effects of three doses of a behavioral intervention for obesity (High dose=24 sessions, Moderate=16 sessions, Low=8 sessions) compared with a nutrition education control group (Control) on binge eating. We also examined whether participants with clinically significant improvements in binge eating had better treatment adherence and weight-loss outcomes than those who did not experience clinically significant improvements in binge eating. Finally, we examined the relation of pretreatment binge eating severity to changes at six months.Methods: Participants included 572 adults (female=78.7%; baseline mean±SD: age=52.7±11.2years, BMI=36.4±3.9kg/m(2)) who provided binge eating data at baseline. We evaluated binge eating severity (assessed via the Binge Eating Scale) and weight status at baseline and six months, as well as treatment adherence over six months.Results: At six months, participants in the Moderate and High treatment conditions reported greater reductions in binge eating severity than participants in the Low and Control conditions, ps<.02. Participants who demonstrated improvements in binge eating severity reported greater dietary self-monitoring adherence and attained larger weight losses than those who did not experience clinically significant reductions, ps<.001. Pretreatment binge eating severity predicted less improvement in binge eating severity over six months and fewer days with dietary self-monitoring records completed, ps≤.002.Conclusion: A moderate or high dose of behavioral weight-loss treatment may be required to produce clinically significant reductions in binge eating severity in adults with obesity. [ABSTRACT FROM AUTHOR]

The College of Public Health and Health Professions at the University of Florida is composed of five public health departments and four clinical health professions departments, and the college is one of six that make up the university’s Health Science Center. These organizational resources, along with the university’s explicit emphasis on collaboration across professions, colleges, institutes, and centers and the strong leadership and full support of deans and other academic leaders, provide a strong foundation for educational innovations. Three key areas in which the college has built upon these opportunities are interprofessional education, development of One Health instructional programs, and application of cutting-edge technology to students’ educational experiences. These innovations represent the types of creative approaches to preparing the 21st-century workforce that can be developed through collaboration among multiple disciplines in a major university. [ABSTRACT FROM AUTHOR]

Abstract: Individuals seeking weight loss treatment endorse unrealistic expectations regarding their goals for weight loss, although these conclusions are primarily based on research conducted in obesity specialty clinics and/or controlled clinical trials. This study examined the weight loss goals and predictors of these goals among patients participating in obesity treatment in an applied, clinical setting (i.e., managed care organization). Managed care patients enrolled in a behavioral weight loss program (N =143; mean age=46.8years; mean BMI=36.9kg/m2; 89.5% female; 64.5% Caucasian) completed a self-report survey during an initial weight loss session. The survey included items assessing patients'' weight loss expectations, including goals for dream, happy, acceptable, and disappointed weights. Participants completed questions regarding contacts with their primary care physician and physician provision of weight loss counseling and/or referrals. They also provided values for current height and weight. BMI''s and weight loss associated with dream, happy, acceptable, and disappointed weight goals were 24.8kg/m2 (30.9% loss), 27.1kg/m2 (25.2% loss), 29.3kg/m2 (19.7% loss), and 33.0kg/m2 (10.4% loss), respectively. There were significant gender differences in weight loss goals, with women endorsing more unrealistic goals than men for dream and happy weights, ps<0.001. Significant predictors of all four weight loss goals included baseline BMI, gender, ethnicity, and frequency of visits with one''s primary care physician, ps<0.01. Consistent with previous research, patients participating in a weight loss program implemented in a managed care setting endorsed unrealistic expectations for weight loss. However, more frequent contact with one''s primary care physician was associated with more realistic goals. Future, longitudinal research is needed to document the discrepancy between these goals and actual weight loss achieved in such settings as well as to determine whether excessive goals are associated with diminished treatment outcomes. [Copyright &y& Elsevier]

The article presents a randomized controlled study which evaluates the extended care programs for weight management in rural communities in northern Florida. According to researchers, rural counties across the U.S. have higher rates of obesity, sedentary lifestyle and associated chronic diseases than nonrural areas. In the study, 234 obese women were randomized to extended care or to an educational control group for weight management. Results reveal that extended care via telephone or face-to-face sessions improved the one year maintenance of lost weight compared with education alone.

Abstract: Participants in weight-loss programs expect unreasonably large weight losses and believe that such reductions will produce dramatic improvements in their lives. The failure to achieve such benefits may contribute to poor maintenance of lost weight. This randomized pilot study investigated a new cognitive–behavioral intervention designed to modify unrealistic expectations regarding weight loss and its likely impact on appearance, attractiveness, and self-esteem. Twenty-eight overweight and obese young women who completed 10 sessions of standard behavioral weight-loss treatment were randomly assigned to 10 additional sessions of either standard behavioral (SB) treatment or a reformulated cognitive–behavioral (RCB) treatment. At posttreatment, the RCB intervention produced more realistic weight-loss expectations, decreased participants'' motivation to lose weight as a means of improving self-confidence, and increased their overall self-esteem, compared with the SB condition (all p''s&#60;.05). The mean posttreatment weight changes achieved in the SB (−6.2±4.5 kg) and RCB (−5.5±3.6 kg) conditions were equivalent, as were the amounts of weight regained during a 6-month follow-up (SB=2.3±2.7 kg; RCB=1.5±1.7 kg). Collectively, these findings indicate that the RCB intervention was effective in changing unrealistic weight-loss expectations, but it did not produce significantly better maintenance of lost weight than did the SB intervention. [Copyright &y& Elsevier]

Background. Common cardiovascular disease risk factors (e.g., insulin and aerobic fitness) are improved with exercise; however, few studies have addressed the potential for training to modify emerging cardiovascular disease risk factors such as homocysteine and high-sensitivity C-reactive protein.Methods. Sedentary adults (n = 324, 48.9 ± 8.4 years) were randomized to four groups differing in training intensity (moderate = 45–55% or high = 65–75% of heart rate reserve) and frequency (low = 3–4, 30-min sessions/week or high = 5–7, 30 min-sessions/week).Results. Within-group changes in homocysteine, insulin, and aerobic fitness were significant (all P < 0.0125). Furthermore, homocysteine increased in the high-intensity–low-frequency (0.98 ± 2.32 μmol/L) and high-intensity–high-frequency (0.93 ± 2.56 μmol/L) groups, while aerobic fitness increased in the moderate-intensity–high-frequency (0.99 ± 2.01 mL min-1 kg-1) and high-intensity–high-frequency (1.77 ± 2.97 mL min-1 kg-1) groups (all P < 0.003). The change in aerobic fitness was greater in the high-intensity–high-frequency compared to the moderate-intensity–low-frequency group (1.77 ± 2.97 vs. 0.36 ± 2.10 mL min-1 kg-1, P = 0.0014) (effect size estimate = 0.60 mL min-1 kg-1). The main effects for intensity, with respect to the change in insulin (effect size estimate = 0.46 μU/mL), and frequency, with respect to the change in aerobic fitness (effect size estimate = 0.38 mL min-1 kg-1), were significant (P < 0.0125).Conclusion. Although frequent bouts of higher intensity exercise were particularly effective in reducing fasting insulin and improving fitness, they resulted in slightly increased homocysteine levels. [Copyright &y& Elsevier]

Objective: To determine the effects of exercise, without weight loss, on insulin sensitivity (S(I)), postheparin plasma lipase activity (PHPL), intravenous fat clearance rate (K(2)), and fasting lipids in sedentary adults.Research Design and Methods: At baseline and after 6 months of walk training (intensity 45-55 or 65-75% heart rate reserve, frequency 3-4 or 5-7 days/week, duration 30 min/session), anthropometric indexes, S(I), PHPL, K(2), and fasting lipids were measured in 18 sedentary adults (12 women, 6 men; 51.9 +/- 5.8 years of age, BMI 28.9 +/- 4.6 kg/m(2)).Results: Exercise increased S(I) (2.54 +/- 2.74 vs. 4.41 +/- 3.30 microU ml(-1) x min(-1), P < 0.005) and both lipoprotein lipase (LPL) (1890 +/- 1380 vs. 4926 +/- 1858 nEq free fatty acid [FFA]. ml(-1). h(-1)) and hepatic lipase (HL) activities (3326 +/- 1605 vs. 4636 +/- 1636 nEq FFA. ml(-1) x h(-1)) (both P < 0.001), without altering BMI, waist circumference, K(2), or fasting lipids. Correlations between changes in LPL and the total:HDL cholesterol ratio (r = -0.54) and changes in the LPL:HL ratio and waist circumference (r = -0.50) were significant (P < 0.05).Conclusions: Exercise, without weight loss, increases S(I) and PHPL activity in previously sedentary adults, without changing K(2) or fasting lipid levels. Furthermore, increased LPL is associated with a decreased total:HDL ratio, and an increased LPL:HL ratio is associated with a decreased waist circumference. Therefore, even modest amounts of exercise in the absence of weight loss positively affect markers of glucose and fat metabolism in previously sedentary, middle-aged adults. [ABSTRACT FROM AUTHOR]

Objective To examine whether the effects of physical and emotional status on adherance to a low-fat (20% energy) dietary pattern are mediated by participation in an intervention program (attending sessions and self-monitoring).Design The Baron and Kenny mediator model, a series of 4 regression analyses, was used to evaluate whether: a) physical and emotional status predicted program participation, b) program participation predicted dietary adherence, c) physical and emotional status factors predicted dietary adherence, and, ultimately d) the effects of physical and emotional status on dietary adherence were mediated by program participation.Subjects/setting Data from 13,277 postmenopausal women randomly assigned to the low-fat intervention arm of the Women''s Health Initiative Dietary Modification Trial.Intervention The nutrition goals for women randomly assigned to the low-fat intervention were to reduce total fat intake to 20% or less of energy from fat and to consume 5 or more fruit/vegetable servings daily and 6 or more grain servings daily.Main outcome measures Year 1 program participation (degree of attending group sessions and submitting fat scores) and adherence to the low-fat dietary pattern (percent energy from fat) as predicted by baseline physical and emotional status (eight SF-36 Health Survey subscales).Results Participating in the dietary intervention program reduced (mediated) the negative effect of poorer mental health on dietary adherence by 15%. Additional findings included that a 10% increase in physical functioning increased session attendance by 0.4% (P<.001) and a 10% increase in mental health predicted a decrease in percent energy from fat of 0.3% (P<.001). Program participation had a marked effect on dietary adherence: a 10% increase in session attendance predicted a 1.2% decrease in percent energy from fat (P<.001).Applications/conclusions Understanding and using instruments to assess the physical and emotional status of a target population will help dietetic professionals promote healthful dietary change and maintenance. J Am Diet Assoc. 2002; 102:789–794, 799–800. [Copyright &y& Elsevier]

Presents a therapy programs for long-term management of obesity. Comparison of therapy programs with standard behavioral treatment; Effectiveness of the extended treatment intervention; Observation of weight-changes differences.

Examines the effects of two aerobic exercise programs in the treatment of obesity. Potential contribution of exercise to the management of obesity; Correlation between weight loss and physical activity; Supervised group exercise sessions; Functional capacity; Treatment adherence.

Discusses the comparison of effects between the problem-solving therapy (PST) and reminiscence therapy (RT) based on divergent conceptualizations of depression in older adults. Baseline demographic characteristics of participants; Measures; Evaluation of differential treatment effects.

This study examined eating regulation among obese persons who applied for weight loss treatment. A forced-preload paradigm was utilized to test (a) whether obese individuals seeking treatment engage in counterregulatory eating and (b) whether restraint, binge eating severity, or body image disparagement moderate the effects of preloads on eating. The results in a sample of 72 clinically overweight women indicated that obese persons seeking weight loss treatment did indeed display counterregulatory eating behavior. When treated as continuous variables, none of the moderator variables interacted with preload status to influence eating in the expected direction. However, when subjects were divided into binge and nonbinge eaters, binge status moderated the effect of preloads on eating. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to compare physicians'' weight loss goals for obese male and female patients. Method: This study was conducted in 2008–2009 in Florida, USA. Physicians (N =108; 79.6% primary care specialty) reviewed two hypothetical clinical scenarios that were identical with respect to health status and obesity (BMI=33 kg/m2) but differed in the gender of the patient. Physicians then completed a survey about the need for weight loss, intentions to provide weight loss counseling, and weight loss goals (i.e., ideal, successful, and acceptable goal weights) for each hypothetical patient. Results: Physicians strongly agreed that both patients should lose weight and physician counseling and/or treatment referrals would be appropriate; however, physician weight loss goals for male and female patients differed. BMI values calculated from the suggested ideal, successful, and acceptable weight goals were significantly lower for female patients than male patients, 22.0 vs. 25. 2 kg/m2; 25.4 vs. 27. 8 kg/m2; and 27.0 vs. 29. 2 kg/m2, respectively, P values <.001. Conclusions: Physicians endorsed significantly more stringent weight loss goals for obese female patients than obese male patients. Regardless of patient gender, physician goals exceeded the 5–10% losses currently recommended. Additional research is needed to better understand this gender discrepancy in physician expectations for obese patients. [Copyright &y& Elsevier]

Summary Obesity and obesity‐related comorbidities disproportionately affect rural communities. Research has emerged in support of a novel acceptance‐based behavioural weight management treatment (ABT) that integrates the principles and procedures of acceptance‐commitment therapy (ACT) with traditional components of standard behavioural treatment (SBT). The current study assessed the perceptions of community stakeholders in rural areas to session materials of a commercially available ABT program. Surveys and focus groups were used to solicit feedback from three former interventionists with experience delivering SBTs in rural counties and from 17 former participants in these programs. Qualitative responses encompassed four overarching themes: (1) recommendations to support participant engagement, (2) comments about preferences for specific ABT and SBT strategies, (3) concerns about specific aspects of treatment delivery, and (4) requests for aesthetic changes to session materials to enhance clarity and engagement. Overall, participants viewed ABT materials and concepts favourably but believed it would be important to begin the intervention with rapport building and training in traditional SBT strategies prior to delving into ACT strategies. Future studies should investigate the efficacy of ABT for weight loss in adults with obesity living in rural communities and continue to solicit feedback from rural community stakeholders. [ABSTRACT FROM AUTHOR]

Summary: Background: General and eating disorder (ED) psychopathology are common among children and adults with overweight/obesity; few studies have examined their course of change throughout family‐based behavioural obesity treatment (FBT) and maintenance. Objectives: Examine: (1) the changes in the parent and child general and ED psychopathology during FBT and maintenance interventions; (2) the associations between change in psychopathology and change in weight among children or parents; (3) the associations between change in psychopathology within parent–child dyads. Methods: 172 parent–child dyads participated in 4‐month FBT and were subsequently randomized to one of three 8‐month maintenance interventions. General psychopathology (child anxiety/depressive symptoms, parent severity of global psychological distress), ED psychopathology (shape/weight concern), and percent overweight were assessed at baseline, post‐FBT, and post‐maintenance. Separate linear mixed‐effects models evaluated change in general and ED psychopathology, including an interaction between maintenance condition and time. Partial correlations examined associations between change in psychopathology and percent overweight among children or parents, and associations between change in psychopathology within parent–child dyads. Results: Among children, significant reductions were observed from baseline to post‐FBT in all forms of psychopathology and from post‐FBT to post‐maintenance in general psychopathology. Among parents, significant reductions were observed from baseline to post‐FBT in all forms of psychopathology; reductions were maintained from post‐FBT to post‐maintenance. There was no significant interaction between maintenance condition and time. Correlations between change in most forms of parent or child psychopathology and percent overweight were observed. Conclusions: Participation in FBT and maintenance was associated with improvements in general and ED psychopathology in both parents and children. [ABSTRACT FROM AUTHOR]

Introduction: Self-monitoring has been shown to be a crucial part of initial weight loss success in behavioral interventions. However, little is known about the impact of self-monitoring during the period following initial treatment.Methods: The current study examined the role of self-monitoring on weight loss during an initial 6-month intervention period (Phase 1) and a 12-month extended care period (Phase 2) in a group of 167 obese women (M±SD: BMI=37.0±5.1kg/m(2), age=59.9±6.2years) enrolled in a behavioral weight loss program.Results: Cluster analysis identified three groups of participants with low, moderate, and high rates of weight loss success during Phase 1 and Phase 2. A one-way ANOVA revealed no significant differences in self-monitoring frequency between groups during Phase 1 (p=.645), but significant differences between all three groups during Phase 2 (p=.001). High success participants completed the most self-monitoring records, followed by the moderate group. The low success group completed the least number of records. Furthermore, self-monitoring during Phase 2 significantly mediated the relationship between extended-care session attendance and percent weight change during that time (95% CI [-.004, -.001], p<.001).Conclusion: These results highlight the importance of continuing self-monitoring after the initial phase of treatment to maintain lost weight. [ABSTRACT FROM AUTHOR]

In this paper, we develop methods for longitudinal quantile regression when there is monotone missingness. In particular, we propose pattern mixture models with a constraint that provides a straightforward interpretation of the marginal quantile regression parameters. Our approach allows sensitivity analysis which is an essential component in inference for incomplete data. To facilitate computation of the likelihood, we propose a novel way to obtain analytic forms for the required integrals. We conduct simulations to examine the robustness of our approach to modeling assumptions and compare its performance to competing approaches. The model is applied to data from a recent clinical trial on weight management. [ABSTRACT FROM AUTHOR]

Abstract: The Extension Family Lifestyle Intervention Project (E-FLIP for Kids) is a three-arm, randomized controlled trial assessing the effectiveness of two behavioral weight management interventions in an important and at-risk population, overweight and obese children and their parents in rural counties. Participants will include 240 parent–child dyads from nine rural counties in north central Florida. Dyads will be randomized to one of three conditions: (a) a Family-Based Behavioral Group Intervention, (b) a Parent-Only Behavioral Group Intervention, and (c) an Education Control Condition. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 12) and follow-up (month 24). Assessment and intervention sessions will be held at Cooperative Extension Service offices within each participating county. The primary outcome measure is change in child BMI z-score. Additional key outcome measures include child body fat, waist circumference, dietary intake, physical activity, blood lipids, blood glucose, blood pressure, physical fitness, quality of life, and program and participants costs. Parent BMI, dietary intake, and physical activity also will be assessed. Randomized controlled trials testing the effectiveness of childhood obesity interventions in real-world community-based settings are extremely valuable, but much too rare. The E-FLIP for Kids trial will evaluate the impact of a community-based intervention delivered to families in rural settings utilizing the existing Cooperative Extension Service network on long-term child behavior, weight status and biological markers of diabetes and early cardiovascular disease. If successful, a Parent-Only intervention program may provide a cost-effective and practical intervention for families in underserved rural communities. [ABSTRACT FROM AUTHOR]

Abstract: Project STORY is a 3-arm, randomized, planning and feasibility study assessing the effectiveness of two behavioral weight management interventions in an important and at-risk population, overweight children and their parents in medically underserved rural counties. Participants will include 90 parent–child dyads from rural counties in north central Florida. Families will be randomized to one of three conditions: (a) a Family-Based Behavioral Group Intervention, (b) a Parent-Only Behavioral Group Intervention, and (c) a waitlist control condition. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 4) and follow-up (month 10). Assessment and intervention sessions will be held at Cooperative Extension offices within each local participating county. The primary outcome measure is change in child body mass index (BMI) z-score. Additional key outcome measures include child dietary intake, physical activity, self-esteem, body image, and parent BMI. The goals of the study are to (a) assess the feasibility of recruitment in rural settings, (b) develop and evaluate training protocol for group leaders, (c) determine strategies to increase adherence to monitoring and goal setting protocol, (d) evaluate strategies for participant retention, (e) assess the relative cost-effectiveness of the interventions, (f) assess the acceptability of the intervention to families and Cooperative Extension administrators and personnel, and (g) if successful, estimate the sample size needed for a full-scale trial. This research has potential implications for medically underserved rural communities with limited resources and preventive health care services. If successful, a Parent-Only intervention program may provide a cost-effective and practical intervention for families in underserved rural communities. [Copyright &y& Elsevier]

Summary: Background: Family‐based behavioural weight loss treatment (FBT) is an evidence‐based intervention for paediatric overweight/obesity (OV/OB), but little research has examined the relative efficacy of FBT across socioeconomic status (SES), and racial groups. Method: A total of 172 youth (7‐11 years; 61.6% female; 70.1% White, 15.7% Black; child percent OV = 64.2 ± 25.2; 14.5% low‐income) completed 4 months of FBT and 8 months of additional intervention (either active social facilitation‐based weight management or an education control condition). Parents reported family income, social status (Barratt simplified measure of social status) and child race at baseline. Household income was dichotomized into < or >50% of the area median family income. Race was classified into White, Black or other/multi‐race. Treatment efficacy was assessed by change in child % OV (BMI % above median BMI for age and sex) and change in child BMI % of 95th percentile (BMI % of the 95th percentile of weight for age and sex). Latent change score models examined differences in weight change between 0 and 4 months, 4 and 12 months and 0 and 12 months by income, social status and race. Results: Black children had, on average, less weight loss by 4 months compared to White children. Low‐income was associated with less weight loss at 4 months when assessed independent of race. No differences by race, social status or income were detected from 4 to 12‐months or from 0 to 12 months. Conclusions: FBT is effective at producing child weight loss across different SES and racial groups, but more work is needed to understand observed differences in initial efficacy and optimize treatment across all groups. [ABSTRACT FROM AUTHOR]

This study examined the psychometric properties of the Medical Coping Modes Questionnaire, a rationally and empirically constructed instrument that purports to measure 3 cognitive-behavioral, illness-related coping strategies. The original 3-factor solution as derived by Feifel et al. (1987a) was tested and compared to 2 additional theoretically derived 1- and 2-factor models using confirmatory factor analysis. Because goodness of fit criteria were not acceptable, and because transplant candidates may use different coping strategies than general medical patients, principal components factor analysis was performed. In addition, internal consistency and construct validity of revised scales and their relation to demographic variables were assessed. A sample of 372 liver, kidney, heart, lung, and bone marrow transplant patients was used. Exploratory factor analysis revealed 4 factors (with an acceptable number of items) that accounted for 45.81% of the variance and consisted of 16 of the original 19 items. Generally, the Avoidance and Acceptance/Resignation subscales were replicated, and the Confrontation scale was split into 2 factors: Social Support Seeking and Information Seeking. Correlations between revised factors and measures of affective distress and quality of life were in the directions expected. Implications for the use of this measure with transplant candidates are discussed. [ABSTRACT FROM AUTHOR]

Background: Concurrent general psychopathology (GP) and eating disorder psychopathology (EDP) are commonly reported among youth with overweight/obesity and may impact weight change.Purpose: We identified patterns of GP and EDP in children with overweight/obesity and examined the impact on weight change following family-based behavioral obesity treatment (FBT) and maintenance interventions.Methods: Children (N = 172) participated in 4 month FBT and subsequent 8 month weight maintenance interventions. GP and EDP were assessed prior to FBT (baseline). Child percentage overweight was assessed at baseline, post-FBT (4 months), and post-maintenance (12 months). Latent profile analysis identified patterns of baseline GP and EDP. Linear mixed-effects models examined if profiles predicted 4- and 12-month change in percentage overweight and if there were two-way and three-way interactions among these variables, adjusting for relevant covariates.Results: Results indicated a three-profile structure: lower GP and EDP (LOWER); subclinically elevated GP and EDP without loss of control (LOC; HIGHER); and subclinically elevated GP and EDP with LOC (HIGHER + LOC). Across profiles, children on average achieved clinically meaningful weight loss (i.e., ≥9 unit change in percentage overweight) from baseline to 4 month FBT and sustained these improvements at 12 month maintenance. There was no evidence that latent profiles were related to percentage overweight change from baseline to FBT (p > .05) or baseline to maintenance (p > .05). There was no evidence for two-way or three-way interactions (p > .05).Conclusion: Concurrent GP and EDP do not portend differential short- or long-term weight change following FBT and maintenance. Future research is warranted on the durability of weight change among youth with GP and EDP.Trial Registration: NCT00759746. [ABSTRACT FROM AUTHOR]

This article focuses on abusive parents. As child abuse becomes an increasingly visible international problem, identifying parents at risk for abuse becomes an important task for mental health professionals. An initial stage in this task is developing reliable screening devices with which clinicians might identify potential abusers for prevention programs or identify those clients who already have been indicated and have a potential for repeated abusive incidents. Although there have been attempts to construct psychometrically sound assessment devices, these have not been employed widely for a variety of reasons.

Importance: Rural populations have a higher prevalence of obesity and poor access to weight loss programs. Effective models for treating obesity in rural clinical practice are needed.Objective: To compare the Medicare Intensive Behavioral Therapy for Obesity fee-for-service model with 2 alternatives: in-clinic group visits based on a patient-centered medical home model and telephone-based group visits based on a disease management model.Design, Setting, and Participants: Cluster randomized trial conducted in 36 primary care practices in the rural Midwestern US. Inclusion criteria included age 20 to 75 years and body mass index of 30 to 45. Participants were enrolled from February 2016 to October 2017. Final follow-up occurred in December 2019.Interventions: All participants received a lifestyle intervention focused on diet, physical activity, and behavior change strategies. In the fee-for-service intervention (n = 473), practice-employed clinicians provided 15-minute in-clinic individual visits at a frequency similar to that reimbursed by Medicare (weekly for 1 month, biweekly for 5 months, and monthly thereafter). In the in-clinic group intervention (n = 468), practice-employed clinicians delivered group visits that were weekly for 3 months, biweekly for 3 months, and monthly thereafter. In the telephone group intervention (n = 466), patients received the same intervention as the in-clinic group intervention, but sessions were delivered remotely via conference calls by centralized staff.Main Outcomes and Measures: The primary outcome was weight change at 24 months. A minimum clinically important difference was defined as 2.75 kg.Results: Among 1407 participants (mean age, 54.7 [SD, 11.8] years; baseline body mass index, 36.7 [SD, 4.0]; 1081 [77%] women), 1220 (87%) completed the trial. Mean weight loss at 24 months was -4.4 kg (95% CI, -5.5 to -3.4 kg) in the in-clinic group intervention, -3.9 kg (95% CI, -5.0 to -2.9 kg) in the telephone group intervention, and -2.6 kg (95% CI, -3.6 to -1.5 kg) in the in-clinic individual intervention. Compared with the in-clinic individual intervention, the mean difference in weight change was -1.9 kg (97.5% CI, -3.5 to -0.2 kg; P = .01) for the in-clinic group intervention and -1.4 kg (97.5% CI, -3.0 to 0.3 kg; P = .06) for the telephone group intervention.Conclusions and Relevance: Among patients with obesity in rural primary care clinics, in-clinic group visits but not telephone-based group visits, compared with in-clinic individual visits, resulted in statistically significantly greater weight loss at 24 months. However, the differences were small in magnitude and of uncertain clinical importance.Trial Registration: ClinicalTrials.gov Identifier: NCT02456636. [ABSTRACT FROM AUTHOR]

Summary: Background: This study aimed to further elucidate correlated weight changes in parent‐child dyads enrolled in family‐based treatment (FBT) by modeling the interdependence of weight changes during treatment. Methods: Parent‐child dyads (n = 172) with overweight/obesity (child mean zBMI = 2.16 ± 0.39; parent mean BMI = 37.9 ± 9.4 kg/m2) completed 4 months of FBT and were randomized to one of three 8‐month maintenance interventions (Social Facilitation Maintenance [SFM]‐high dose, SFM‐low dose or control). Weight/height was measured at 0, 4 and 12 months. Structural equation models simultaneously estimated the effect that an individual had on their own (actor effect) and on one another's (partner effect) weight‐status across time using the actor‐partner interdependence model. Results: Actor paths were significant over time for parent and child. Partner paths were significant for child zBMI predicting parent BMI at 4 and 12 months. Maintenance condition moderated actor/partner paths in the model. Conclusions: Child weight change may motivate parents to make environmental and behavioural changes that impact their own weight. Trial Registration: ClinicalTrials.gov Identifier: NCT00759746. [ABSTRACT FROM AUTHOR]

Purpose: To determine characteristics of weight gain prevention programs that facilitate engagement. Design: Randomized factorial experiment (5 × 2). Setting: Recruited nationally online. Participants: Adults aged 18 to 75 with body mass index ≥25 who decline a behavioral weight loss intervention (n = 498). Measures: Participants were randomly presented with one of 10 possible descriptions of hypothetical, free weight gain prevention programs that were all low dose and technology-based but differed in regard to 5 behavior change targets (self-weighing only; diet only; physical activity only; combined diet, physical activity, and self-weighing; or choice between diet, physical activity, and self-weighing targets) crossed with 2 financial incentive conditions (presence or absence of incentives for self-monitoring). Participants reported willingness to join the programs, perceived program effectiveness, and reasons for declining enrollment. Analysis: Logistic regression and linear regression to test effects of program characteristics offered on willingness to initiate programs and programs' perceived effectiveness, respectively. Content analyses for open-ended text responses. Results: Participants offered the self-weighing-only programs were more willing to initiate than those offered the programs targeting all 3 behaviors combined (50% vs 36%; odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.01-3.13). Participants offered the programs with financial incentives were more willing to initiate (50% vs 33%; OR = 2.08; 95% CI, 1.44-2.99) and anticipated greater intervention effectiveness (β =.34, P =.02) than those offered no financial incentives. Reasons for declining to initiate included specific program features, behavior targets, social aspects, and benefits. Conclusion: Targeting self-weighing and providing financial incentives for self-monitoring may result in greater uptake of weight gain prevention programs. Study Preregistration: https://osf.io/b9zfh, June 19, 2018. [ABSTRACT FROM AUTHOR]

Rural Americans have higher prevalence of obesity and type 2 diabetes (T2D) than urban populations and more limited access to behavioral programs to promote healthy lifestyle habits. Descriptive evidence from the Rural Lifestyle Intervention Treatment Effectiveness trial delivered through local cooperative extension service offices in rural areas previously identified that behavioral modification with both nutrition education and coaching resulted in a lower program delivery cost per kilogram of weight loss maintained at 2-years compared with an education-only comparator intervention. This analysis extended earlier Rural Lifestyle Intervention Treatment Effectiveness trial research regarding weight loss outcomes to assess whether nutrition education with behavioral coaching delivered through cooperative extension service offices is cost-effective relative to nutrition education only in reducing T2D cases in rural areas. A cost-utility analysis was conducted. Trial participants (n=317) from June 2008 through June 2014 were adults residing in rural Florida counties with a baseline body mass index between 30 and 45, but otherwise identified as healthy. Trial participants were randomly assigned to low, moderate, or high doses of behavioral coaching with nutrition education (ie, 16, 32, or 48 sessions over 24 months) or a comparator intervention that included 16 sessions of nutrition education without coaching. Participant glycated hemoglobin level was measured at baseline and the end of the trial to assess T2D status. T2D categories by treatment arm were used to estimate participants' expected annual health care expenditures and expected health-related utility measured as quality adjusted life years (ie, QALYs) over a 5-year time horizon. Discounted incremental costs and QALYs were used to calculate incremental cost-effectiveness ratios for each behavioral coaching intervention dose relative to the education-only comparator. Using a third-party payer perspective, Markov transition matrices were used to model participant transitions between T2D states. Replications of the individual participant behavior were conducted using Monte Carlo simulation. All three doses of the behavioral coaching intervention had lower expected total costs and higher estimated QALYs than the education-only comparator. The moderate dose behavioral coaching intervention was associated with higher estimated QALYs but was costlier than the low dose; the moderate dose was favored over the low dose with willingness to pay thresholds over $107,895/QALY. The low dose behavioral coaching intervention was otherwise favored. Because most rural Americans live in counties with cooperative extension service offices, nutrition education with behavioral coaching programs similar to those delivered through this trial may be effective and efficient in preventing or delaying T2D-associated consequences of obesity for rural adults. [ABSTRACT FROM AUTHOR]

A majority of U.S. college-aged women experience body-image dissatisfaction, which puts them at heightened risk for the development of an eating disorder. However, evidence-based psychological interventions for body-image dissatisfaction in this population are not broadly available due to the limited number of trained counselors. We evaluated the efficacy of yoga as a novel treatment for body-image dissatisfaction in otherwise healthy U.S. college-aged women. Female participants between the ages of 18-30 were randomly assigned to twice weekly yoga classes for 12 weeks or to a wait-listed control condition. Compared to participants in the control condition, participants in the yoga condition reported significantly greater improvements in appearance evaluation and satisfaction with specific body areas at post-test. Participants in the yoga condition also reported larger reductions in the amount of time and energy spent preoccupied with their appearance. The results of the current study suggest that yoga, which is widely available across the country, could help college-aged women develop healthier relationships with their bodies. Health professionals and college administrators may want to encourage young women with body-image dissatisfaction to practice yoga in order to improve their self-image. [ABSTRACT FROM AUTHOR]

Background: Behavioral interventions for obesity produce clinically meaningful weight loss, but weight regain following treatment is common. Extended care programs attenuate weight regain and improve weight loss maintenance. However, less is known about the most effective ways to deliver extended care, including contact schedules. Methods: We compared the 12-month weight regain of an extended care program utilizing a non-conventional, clustered campaign treatment schedule and a self-directed program among individuals who previously achieved ≥5% weight reductions. Participants (N = 108; mean age = 51.6 years; mean weight = 92.6 kg; 52% African American; 95% female) who achieved ≥5% weight loss during an initial 16-week behavioral obesity treatment were randomized into a 2-arm, 12-month extended care trial. A clustered campaign condition included 12 group-based visits delivered in three, 4-week clusters. A self-directed condition included provision of the same printed intervention materials but no additional treatment visits. The study was conducted in a U.S. academic medical center from 2011 to 2015. Results: Prior to randomization, participants lost an average of -7.55 ± 3.04 kg. Participants randomized to the 12- month clustered campaign program regained significantly less weight (0.35 ± 4.62 kg) than self-directed participants (2.40 ± 3.99 kg), which represented a significant between-group difference of 2.28 kg (p = 0.0154) after covariate adjustments. This corresponded to maintaining 87% and 64% of lost weight in the clustered campaign and self-directed conditions, respectively, which was a significant between-group difference of 29% maintenance of lost weight after covariate adjustments, p = 0.0396. Conclusions: In this initial test of a clustered campaign treatment schedule, this novel approach effectively promoted 12-month maintenance of lost weight. Future trials should directly compare the clustered campaigns with conventional (e.g., monthly) extended care schedules. [ABSTRACT FROM AUTHOR]

This study evaluated the psychometric properties of the Youth Eating Disorder Examination Questionnaire (YEDE-Q) and its utility for detecting loss of control (LOC) eating (i.e., eating episodes, regardless of size, involving a perceived inability to control what or how much one is eating) among school-age children with overweight or obesity. Identifying eating pathology, particularly LOC eating, in this population may facilitate treatment that improves weight outcomes and reduces eating disorder risk. Children with overweight or obesity ( N = 241; 7-11 years) completed the YEDE-Q and abbreviated Child EDE (ChEDE) to assess LOC eating, prior to entering a weight management treatment trial. Confirmatory factor analyses (CFA) were conducted on children's YEDE-Q responses and compared to the standard adult EDE-Q factor structure and newer, alternate factor structures. CFA supported a three-factor structure, which distinguished youth with versus without LOC. The YEDE-Q showed low accuracy for detecting LOC eating as measured by the ChEDE, which served as the gold-standard benchmark (AUC = 0.69). Among children who endorsed LOC eating, more episodes per month were reported on the YEDE-Q than ChEDE ( p < .001). The YEDE-Q may not have utility as a screener for identifying true cases of LOC eating among school-age children with overweight or obesity. Further evaluation of the YEDE-Q and the alternate three-factor structure is warranted. [ABSTRACT FROM AUTHOR]

Obesity disproportionately affects rural residents in the United States, and primary care has the potential to fill a major gap in the provision of weight management services for rural communities. The objective of this cluster-randomized pragmatic trial is to evaluate the comparative effectiveness of three obesity treatment models in rural primary care: the Intensive Behavior Therapy fee-for-service (FFS) model reimbursed by Medicare, a team-based model that recognizes the patient-centered medical home (PCMH) as a preferred delivery approach, and the centralized disease management (DM) model, in which phone-based counseling is provided outside of the primary care practice. We hypothesize that the PCMH and DM treatments will be more effective than FFS in reducing weight at 24 months. Thirty-six practices from the rural Midwestern U.S. are randomized to deliver one of the three interventions to 40 patients (N = 1440) age 20 to 75 with a BMI 30–45 kg/m 2 . In the FFS arm, primary care providers and their personnel counsel patients to follow evidence-based weight loss guidelines using the Medicare-designated treatment schedule. In the PCMH arm, patients receive a comprehensive weight management intervention delivered locally by practice personnel using a combination of in-person and phone-based group sessions. In the DM arm, the same intervention is delivered remotely by obesity treatment specialists via group conference calls. The primary outcome is weight loss at 24 months. Additional measures include fasting glucose, lipids, quality of life indicators, and implementation process measures. Findings will illuminate effective obesity treatment intervention(s) in rural primary care. [ABSTRACT FROM AUTHOR]

Background Reducing consumption of food away from home is often targeted during pediatric obesity treatment, given the associations with weight status and gain. However, the effects of this dietary change on weight loss are unknown. Objective Our aim was to evaluate associations between changes in dietary factors and child anthropometric outcomes after treatment. It is hypothesized that reduced consumption of food away from home will be associated with improved dietary intake and greater reductions in anthropometric outcomes (standardized body mass index [BMI] and percent body fat), and the relationship between food away from home and anthropometric outcomes will be mediated by improved child dietary intake. Design We conducted a longitudinal evaluation of associations between dietary changes and child anthropometric outcomes. Child diet (three 24-hour recalls) and anthropometric data were collected at baseline and 16 weeks. Participants/setting Participants were 170 overweight and obese children ages 7 to 11 years who completed a 16-week family-based behavioral weight-loss treatment as part of a larger multi-site randomized controlled trial conducted in two cohorts between 2010 and 2011 (clinical research trial). Intervention Dietary treatment targets during family-based behavioral weight-loss treatment included improving diet quality and reducing food away from home. Main outcome measures The main outcome measures in this study were child relative weight (standardized BMI) and body composition (percent body fat). Statistical analyses We performed t tests and bootstrapped single-mediation analyses adjusting for relevant covariates. Results As hypothesized, decreased food away from home was associated with improved diet quality and greater reductions in standardized BMI ( P <0.05) and percent body fat ( P <0.01). Associations between food away from home and anthropometric outcomes were mediated by changes in diet quality. Specifically, change in total energy intake and added sugars mediated the association between change in food away from home and standardized BMI, and change in overall diet quality, fiber, added sugars, and added fats mediated the association between change in food away from home and percent body fat. Including physical activity as a covariate did not significantly impact these findings. Conclusions These results suggest that reducing food away from home can be an important behavioral target for affecting positive changes in both diet quality and anthropometric outcomes during treatment. [ABSTRACT FROM AUTHOR]

Background. Behavioral interventions for obesity are commonly delivered in groups, although the effect of group size on weight loss has not been empirically evaluated. This behavioral weight loss trial compared the 6- and 12-month weight changes associated with interventions delivered in a large group (LG) or small groups (SG). Methods. Obese adults (N = 66; mean age = 50 years; mean BMI = 36.5 kg/m2; 47% African American; 86% women) recruited from a health maintenance organization were randomly assigned to: 1) LG treatment (30 members/group), or 2) SG treatment (12 members/group). Conditions were comparable in frequency and duration of treatment, which included 24 weekly group sessions (months 1–6) followed by six monthly extended care contacts (months 7–12). A mixed effects model with unstructured covariance matrix was applied to analyze the primary outcome of weight change while accounting for baseline weight and dependence among participants’ measurements over time. Results. SG participants lost significantly more weight than LG participants at Month 6 (−6.5 vs. -3.2 kg; p = 0.03) and Month 12 (−7.0 vs. -1.7 kg; p < 0.002). SG participants reported better treatment engagement and self-monitoring adherence at Months 6 and 12, ps < 0.04, with adherence fully mediating the relationship between group size and weight loss. Conclusions. Receiving obesity treatment in smaller groups may promote greater weight loss and weight loss maintenance. This effect may be due to improved adherence facilitated by SG interactions. These novel findings suggest that the perceived efficiency of delivering behavioral weight loss treatment to LGs should be balanced against the potentially better outcomes achieved by a SG approach. [ABSTRACT FROM AUTHOR]

Abstract: Obesity is a risk factor for breast cancer recurrence and death. Women who reside in rural areas have higher obesity prevalence and suffer from breast cancer treatment-related disparities compared to urban women. The objective of this 5-year randomized controlled trial is to compare methods for delivering extended care for weight loss maintenance among rural breast cancer survivors. Group phone-based counseling via conference calls addresses access barriers, is more cost-effective than individual phone counseling, and provides group support which may be ideal for rural breast cancer survivors who are more likely to have unmet support needs. Women (n=210) diagnosed with Stage 0 to III breast cancer in the past 10years who are ≥3months out from initial cancer treatments, have a BMI 27–45kg/m2, and have physician clearance were enrolled from multiple cancer centers. During Phase I (months 0 to 6), all women receive a behavioral weight loss intervention delivered through group phone sessions. Women who successfully lose 5% of weight enter Phase II (months 6 to 18) and are randomized to one of two extended care arms: continued group phone-based treatment or a mail-based newsletter. During Phase III, no contact is made (months 18 to 24). The primary outcome is weight loss maintenance from 6 to 18months. Secondary outcomes include quality of life, serum biomarkers, and cost-effectiveness. This study will provide essential information on how to reach rural survivors in future efforts to establish weight loss support for breast cancer survivors as a standard of care. [Copyright &y& Elsevier]

Background. Accumulating evidence suggests that both dietary restriction and exercise (DR + E) should be incorporated in weight loss interventions to treat obese, older adults. However, more information is needed on the effects to lower extremity tissue composition—an important consideration for preserving mobility in older adults. Methods. Twenty-seven sedentary women (body mass index: 36.3±5.4kg/m2; age: 63.6±5.6 yrs) were randomly assigned to 6 months of DR + E or a health education control group. Thigh and calf muscle, subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) size were determined using magnetic resonance imaging. Physical function was measured using a long-distance corridor walk and knee extension strength. Results. Compared with control, DR + E significantly reduced body mass (-6.6±3.7kg vs control: -0.05±3.5kg; p < .01). Thigh and calf muscle volumes responded similarly between groups. Within the DR + E group, adipose tissue was reduced more in the thigh than in the calf (p < .04). Knee extension strength was unaltered by DR + E, but a trend toward increased walking speed was observed in the DR + E group (p = .09). Post hoc analyses showed that reductions in SAT and IMAT within the calf, but not the thigh, were associated with faster walking speed achieved with DR + E (SAT: r = -0.62; p = .01; IMAT: r = -0.62; p = .01). Conclusions. DR + E preserved lower extremity muscle size and function and reduced regional lower extremity adipose tissue. Although the magnitude of reduction in adipose tissue was greater in the thigh than the calf region, post hoc analyses demonstrated that reductions in calf SAT and IMAT were associated with positive adaptations in physical function. [ABSTRACT FROM PUBLISHER]

The National Institutes of Health convened a workshop to engage researchers and practitioners in dialogue on research issues viewed as either unique or of particular relevance to rural areas, key content areas needed to inform policy and practice in rural settings, and ways rural contexts may influence study design, implementation, assessment of outcomes, and dissemination. Our purpose was to develop a research agenda to address the disproportionate burden of cardiovascular disease (CVD) and related risk factors among populations living in rural areas. Complementary presentations used theoretical and methodological principles to describe research and practice examples from rural settings. Participants created a comprehensive CVD research agenda that identified themes and challenges, and provided 21 recommendations to guide research, practice, and programs in rural areas. INSETS: Workshop Presentations;Guiding Principles for Cardiovascular Disease Research in Rural..;Opportunities for Cardiovascular Disease Research in Rural.... [ABSTRACT FROM AUTHOR]

Objective: Although behavioral weight-loss interventions produce short-term weight loss, long-term maintenance remains elusive. This randomized trial examined whether learning a novel set of "stability skills" before losing weight improved long-term weight management. Stability skills were designed to optimize individuals' current satisfaction with lifestyle and self-regulatory habits while requiring the minimum effort and attention necessary. Method: Overweight/obese women (N = 267) were randomly assigned to one of two 6-month interventions and assessed at baseline and at 6,12, and 18 months. Maintenance First women participated first in an 8-week stability skills maintenance module and then in a standard 20-week behavioral weight-loss program. Weight Loss First women participated first in a standard 20-week behavioral weight-loss program and then in a standard 8-week problem-solving skills maintenance module. There was no intervention staff contact during the 12-month follow-up period (6-18 months). Results: As designed, Maintenance First participants lost the same percentage of initial weight during the 6-month intervention period as Weight Loss First participants (M = -8.6%, SD = 5.7, vs. M = -9.1%, SD = 6.9; t = -0.6, p = .52). However, Maintenance First participants regained significantly less weight during the 12-month follow-up period (6-18 months) than Weight Loss First participants (M = 3.2 lb, SD = 10.4, vs. M = 7.3 lb, SD = 9.9 [M = 1.4 kg, 50 = 4.7, vs. M = 3.3 kg, 50 = 4.5]; t - 3.3, p = .001, d = 0.4). Conclusion: Learning stability skills before losing weight was successful in helping women to maintain weight loss without intervention staff contact during follow-up. These results can inform the study design of future innovative interventions. [ABSTRACT FROM AUTHOR]

Objective: Our goal was to determine whether behavioral economic constructs--including impulsivity (i.e., steep discounting of delayed food and monetary rewards), the relative reinforcing value of food (RRVfood), and environmental enrichment (i.e., the presence of alternatives to unhealthy foods in the home and neighborhood environments)--are significant pretreatment predictors of overweight children's weight loss within family-based treatment. Method: Overweight children (N = 241; ages 7-12 years; 63% female; 65% non-Hispanic White) enrolled in a 16-week family-based obesity treatment with at least one parent. At baseline, children completed a task to assess RRVfood and delay discounting measures of snack foods and money to assess impulsivity. Parents completed questionnaires to assess environmental enrichment. Results: Children who found food highly reinforcing and steeply discounted future food rewards at baseline showed a blunted response to treatment compared with children without this combination of risk factors. High environmental enrichment was associated with treatment success only among children who did not find food highly reinforcing. Monetary discounting rate predicted weight loss, regardless of children's level of RRVfood. Conclusions: Investigation is warranted into novel approaches to obesity treatment that target underlying impulsivity and RRVfood. Enriching the environment with alternatives to unhealthy eating may facilitate weight loss, especially for children with low RRVfood. [ABSTRACT FROM AUTHOR]

We propose a nonparametric Bayesian approach to estimate the natural direct and indirect effects through a mediator in the setting of a continuous mediator and a binary response. Several conditional independence assumptions are introduced (with corresponding sensitivity parameters) to make these effects identifiable from the observed data. We suggest strategies for eliciting sensitivity parameters and conduct simulations to assess violations to the assumptions. This approach is used to assess mediation in a recent weight management clinical trial. [ABSTRACT FROM AUTHOR]

Abstract: Background: A major challenge after successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge can be exacerbated in rural areas with limited local support resources. Objective: This study describes and compares program costs and cost effectiveness for 12-month extended-care lifestyle maintenance programs after an initial 6-month weight-loss program. Design: We conducted a 1-year prospective randomized controlled clinical trial. Participants/setting: The study included 215 female participants age 50 years or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003 to May 31, 2007. Intervention: The intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly assigned to a 12-month extended-care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). Main outcome measures: Program delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. Statistical analyses performed: Nonparametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. Results: Median weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared with individual telephone counseling ($268 per participant) and control ($226 per participant) programs. Although the net weight lost after the 12-month maintenance program was higher for the face-to-face and telephone programs compared with the control group, the average cost per expected kilogram of weight lost was higher for the face-to-face program ($47/kg) compared with the other two programs (approximately $33/kg for telephone and control). Conclusions: Both the scale of operations and local demand for programs are important considerations in selecting a delivery format for lifestyle maintenance. In this study, the telephone format had a lower cost but similar outcomes compared with the face-to-face format. [Copyright &y& Elsevier]

The article presents a study which examines whether improvements in cardiorespiratory fitness can be achieve by previously sedentary adults who use walking as the mode for exercise to achieve physical activity. It states that majority of the participants who walked has achieve fitness improvements significantly. Moreover, participants accumulating 150 minutes or more per week of fast-paced walking achieve improvements in cardiorespiratory fitness.

Obese older adults are particularly susceptible to sarcopenia and have a higher prevalence of disability than their peers of normal weight. Interventions to improve body composition in late life are crucial to maintaining independence. The main mechanisms underlying sarcopenia have not been determined conclusively, but chronic inflammation, apoptosis, and impaired mitochondrial function are believed to play important roles. It has yet to be determined whether impaired cellular quality control mechanisms contribute to this process. The objective of this study was to assess the effects of a 6-month weight loss program combined with moderate-intensity exercise on the cellular quality control mechanisms autophagy and ubiquitin-proteasome, as well as on inflammation, apoptosis, and mitochondrial function, in the skeletal muscle of older obese women. The intervention resulted in significant weight loss (8.0 ± 3.9 % vs. 0.4 ± 3.1% of baseline weight, p = 0.002) and improvements in walking speed (reduced time to walk 400 meters, - 20.4 ± 16% vs. - 2.5 ± 12%, p = 0.03). In the intervention group, we observed a three-fold increase in messenger RNA (mRNA) levels of the autophagy regulators LC3B, Atg7, and lysosome-associated membrane protein-2 (LAMP-2) compared to controls. Changes in mRNA levels of FoxO3A and its targets MuRF1, MAFBx, and BNIP3 were on average seven-fold higher in the intervention group compared to controls, but these differences were not statistically significant. Tumor necrosis factor-α (TNF-α) mRNA levels were elevated after the intervention, but we did not detect significant changes in the downstream apoptosis markers caspase 8 and 3. Mitochondrial biogenesis markers (PGC1α and TFAm) were increased by the intervention, but this was not accompanied by significant changes in mitochondrial complex content and activity. In conclusion, although exploratory in nature, this study is among the first to report the stimulation of cellular quality control mechanisms elicited by a weight loss and exercise program in older obese women. [ABSTRACT FROM AUTHOR]

The article discusses a translational, randomized controlled trial of physical activity (PA) and weight loss (WL) on mobility in overweight or obese older adults with poor cardiovascular health. Participants were randomized to one of three interventions which include PA, WL and PA or a successful aging (SA) education control arm. Individuals in the WL and PA group had improved their 400-meter walk in seconds (400MWT) compared with other groups.

A primary focus of longevity research is to identify prognostic risk factors that can be mediated by early treatment efforts. To date, much of this work has focused on understanding the biological processes that may contribute to aging process and age related disease conditions. Although such processes are undoubtedly important, no current biological intervention aimed at increasing health and lifespan exists. Interestingly, a close relationship between mobility performance and the aging process has been documented in older adults. For example, recent studies have identified functional status, as assessed by walking speed, as a strong predictor of major health outcomes, including mortality, in older adults. This paper aims to describe the relationship between the comorbidities related to decreased health and lifespan and mobility function in obese, older adults. Concurrently, lifestyle interventions, including diet and exercise, are described as a means to improve mobility function and thereby limit the functional limitations associated with increased mortality. [ABSTRACT FROM AUTHOR]

Abstract: Rural women have among the highest rates of obesity and sedentary lifestyle, yet few studies have examined strategies for delivering state-of-the-art obesity treatment to hard-to-reach rural areas. The purpose of this pilot trial was to examine the impact and cost-effectiveness of a 6-month behavioral weight loss program delivered to rural women by phone either one-on-one with a counselor or to a group via conference call. Thirty-four rural women (mean BMI=34.4, SD=4.6) were randomized to group phone-based treatment or individual phone-based treatment. Completers analysis showed that weight loss was greater in the group condition (mean=14.9kg=, SD=4.4) compared to the individual condition (mean=9.5kg, SD=5.2; p =.03). Among the total sample, 62% of participants in the group condition achieved the 10% weight loss goal compared to 50% in the individual condition, and group treatment was found to be more cost-effective. Future research is warranted to examine the benefits of group phone-based treatment for long-term management of obesity among rural populations. [Copyright &y& Elsevier]

Abstract: Objective: This study examined whether improvements in problem-solving abilities mediate the relation between treatment adherence and weight-loss outcome in the behavioral treatment of obesity. Method: 272 women (mean±SD age=59.4±6.2 years, BMI=36.5±4.8) participated in a 6-month lifestyle intervention for obesity. Body weight and problem-solving skills (as measured by the Social Problem Solving Inventory—Revised) were assessed pre- and posttreatment. The completion of self-monitoring logs during the intervention served as the marker of treatment adherence. Results: At posttreatment, participants lost 8.4±5.8 kg, an 8.8% reduction in body weight. Changes in weight were associated with increased problem-solving skills and with higher levels of treatment adherence. Improvements in problem-solving skills partially mediated the relation between treatment adherence and weight-loss outcome. Moreover, participants with weight reductions ≥10% demonstrated significantly greater improvements in problem-solving skills than those with reductions <5%. Discussion: Improvements in problem-solving skills may enable participants to overcome barriers to adherence and thereby enhance treatment-induced weight losses. [Copyright &y& Elsevier]

Abstract: The relative contribution of obesity versus poor fitness to adverse health outcomes and diminished quality of life remains an area of controversy. Indeed, some researchers contend that poor cardiorespiratory fitness represents a greater threat to health and health-related quality of life than excess body weight. We addressed this issue by providing 298 obese 50–75 year-old women with a six-month lifestyle intervention that incorporated a low-calorie eating pattern coupled with an aerobic exercise program consisting of 30 min/day of brisk walking. The results showed that weight loss exhibited a significant individual contribution to improvements in seven of the nine domains of quality of life assessed by the Medical Outcomes Study Short Form (SF-36). With the exception of physical functioning, however, physical fitness did not significantly contribute to improvements beyond the effects weight loss. Moreover, weight loss functioned as a full mediator of the association between increases in physical fitness and improvements in general health, vitality, and change in health relative to the previous year. Collectively, these findings suggest that for treatment-seeking obese individuals, weight loss rather than increased fitness contributes significantly to improvements in health-related quality of life. [Copyright &y& Elsevier]