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Past studies have suggested that weight loss history is associated with subsequent weight loss. However, questions remain whether method and amount of weight lost in previous attempts impacts current weight loss efforts. This study utilized data from the Weight Loss Maintenance Trial to examine the association between weight loss history and weight loss outcomes in a diverse sample of high-risk individuals. Multivariate regression analysis was conducted to determine which specific aspects of weight loss history predict change in weight during a 6-month weight loss intervention. Greater weight loss was predicted by fewer previous weight loss attempts with assistance (p = 0.03), absence of previous dietary/herbal weight loss supplement use (p = 0.01), and greater maximum weight loss in previous attempts (p < 0.001). Future interventions may benefit from assessment of weight loss history and tailoring of interventions based on past weight loss behaviors and outcomes. Keywords Weight loss history * Previous weight * Weight loss method * Behavioral * Lifestyle * Greatest weight loss, Introduction Recent estimates indicate that 34.2 % of Americans are overweight and an additional 33.8 % of Americans are obese (Flegal et al., 2010). Overweight and obesity have serious individual [...]

Purpose: To evaluate the implementation and effectiveness of the Carolina Heart Alliance Networking for Greater Equity (CHANGE) Program, an adapted evidence-based cardiovascular disease risk reduction intervention delivered by Community Health Workers (CHW) to rural adults. Design: Hybrid implementation-effectiveness study with a pre–post design. Setting: North Carolina Federally Qualified Health Center and local health department in a rural, medically underserved area. Sample: Participants (n = 255) included 87% Non-Hispanic Black with a mean age of 57 years; 84% had diagnosed hypertension, 55% had diabetes, and 65% had hypercholesterolemia. Intervention: A CHW-delivered, low-intensity, 4-month behavioral lifestyle intervention promoting a southern-style Mediterranean dietary pattern and physical activity. Measures: We measured number and representativeness of participants reached and retained, intervention delivery fidelity, weight, blood pressure, and self-reported dietary and physical activity behaviors. Analysis: Pre–post changes at 4 months were analyzed using paired t-tests. Results: Study participants completed 90% of planned intervention contacts; 87% were retained. Intervention delivery fidelity measures showed participants receiving a mean of 3.5 counseling visits, 2.7 booster calls, and on average completing 1.7 modules, setting 1.8 goals, and receiving 1.3 referrals per visit. There were significant mean reductions in systolic (−2.5 mmHg, P <.05) and diastolic blood pressure (−2.1 mmHg, P <.01); the proportion of participants with systolic blood pressure <130 increased by 7 % points (P =.05), and diastolic pressure <80 by 9 percentage points (P <.01). Dietary behaviors improved significantly with average weekly servings of nuts increased by.5 serving (P <.0001), and fruits and vegetables by.8 daily serving (P <.0001). Physical activity also increased on average by 45 min./week (P <.001). Weight did not change significantly. Conclusions: The CHANGE program showed both implementation and program effectiveness and adds to the evidence supporting CHW-delivered lifestyle interventions to reduce CVD risk among rural, Non-Hispanic Black, and medically underserved populations. [ABSTRACT FROM AUTHOR]

Byline: Carmen D. Samuel-Hodge, PhD, MS, RD (Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, Carmen_samuel@unc.edu); Daphne C. Watkins, PhD (University of [...]

Background Brief dietary assessment tools are needed to guide counseling in underserved populations to reduce cardiovascular disease (CVD) risk. The Dietary Risk Assessment is one such tool modified over time to reflect emerging evidence concerning diet and CVD risk. Objective To examine the capacity of the modified Dietary Risk Assessment tool to measure aspects of diet quality in a sample of underserved, midlife (aged 40 to 64 years) women, by comparing Dietary Risk Assessment results to those of a longer food frequency questionnaire (FFQ) and with serum carotenoids. Design This study used baseline data from women enrolled in a CVD risk reduction intervention trial. The Dietary Risk Assessment was administered to 236 women and results were compared to those from a longer FFQ administered to 104 women, and to serum carotenoids results from all participants. Results Correlations between Dietary Risk Assessment indexes and corresponding measures from the FFQ were statistically significant: fruit and vegetable, r=-0.53 (P<0.0001, correlation is negative as a lower Dietary Risk Assessment score indicates greater fruit and vegetable intake); saturated fat, r=0.60 (P<0.0001). In linear regression models stratified by smoking and adjusted for body mass index, low-density lipoprotein cholesterol level, high-density lipoprotein cholesterol level, very-lowdensity lipoprotein cholesterol level, and age, the Dietary Risk Assessment fruit and vegetable index was significantly associated with serum carotenoids (parameter estimate for nonsmokers -0.22, P=0.01; smokers -0.45, P=0.003). Correlation coefficients between Dietary Risk Assessment total score and three diet quality index scores derived from FFQ variables were statistically significant, ranging in magnitude from 0.57 to 0.60. Conclusions The modified Dietary Risk Assessment provides a reasonable assessment of dietary factors associated with CVD risk; thus, it is appropriate for use to guide dietary counseling in CVD prevention programs for underserved, midlife, women.

Background For most individuals, long-term maintenance of weight loss requires long-term, supportive intervention. Internet-based weight loss maintenance programs offer considerable potential for meeting this need. Careful design processes are required to maximize adherence and minimize attrition. ObjectiveThis paper describes the development, implementation and use of a Web-based intervention program designed to help those who have recently lost weight sustain their weight loss over 1 year. MethodsThe weight loss maintenance website was developed over a 1-year period by an interdisciplinary team of public health researchers, behavior change intervention experts, applications developers, and interface designers. Key interactive features of the final site include social support, self-monitoring, written guidelines for diet and physical activity, links to appropriate websites, supportive tools for behavior change, check-in accountability, tailored reinforcement messages, and problem solving and relapse prevention training. The weight loss maintenance program included a reminder system (automated email and telephone messages) that prompted participants to return to the website if they missed their check-in date. If there was no log-in response to the email and telephone automated prompts, a staff member called the participant. We tracked the proportion of participants with at least one log-in per month, and analyzed log-ins as a result of automated prompts. ResultsThe mean age of the 348 participants enrolled in an ongoing randomized trial and assigned to use the website was 56 years; 63% were female, and 38% were African American. While weight loss data will not be available until mid-2008, website use remained high during the first year with over 80% of the participants still using the website during month 12. During the first 52 weeks, participants averaged 35 weeks with at least one log-in. Email and telephone prompts appear to be very effective at helping participants sustain ongoing website use. ConclusionsDeveloping interactive websites is expensive, complex, and time consuming. We found that extensive paper prototyping well in advance of programming and a versatile product manager who could work with project staff at all levels of detail were essential to keeping the development process efficient. Trial Registrationclinicaltrials.gov NCT00054925

Black women typically lose small amounts of weight in behavioral weight loss interventions, partially due to low engagement in physical activity. Culturally relevant enhancement of the physical activity component may improve weight loss. This study compared the effectiveness of a culturally-relevant, physical activity-enhanced behavioral weight loss intervention to a standard behavioral weight loss intervention in Black women (n = 85) over 6 months. The study was conducted in two cohorts from March 2016 to February 2017 at the University of North Carolina at Chapel Hill. Participants had an average age of 48.30 ± 11.02 years with an average body mass index of 36.46 ± 4.50 kg/m2. Standard and enhanced groups' weight change (−2.83 kg and −2.08 kg, respectively) and change in physical activity (43.93 min/ week and 15.29 min/week, respectively) did not differ between groups. Significantly more standard group participants lost 5% of baseline weight compared to enhanced group participants. This study produced typical weight loss results in Black women. Behavioral weight loss treatment remains moderately effective for Black women. Strategies to increase attendance and self-monitoring, and the inclusion of cultural contexts to weight-related behaviors are needed to improve outcomes. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to assess factors that influence demand for the Diabetes Prevention Program (DPP) from the perspectives of potential program participants and providers. Methods A qualitative study guided by a conceptual framework was conducted with potential DPP participants and potential DPP providers. Five focus groups with potential participants (n = 37) and key informant interviews with potential providers (n = 14) were conducted in community settings across North Carolina. Results Although providers considered prediabetes to be an important health problem, potential DPP participants expressed less urgency related to a diagnosis of prediabetes. Potential participants felt that they were more likely to adopt diabetes prevention programs if affordable and convenient. For potential program providers, funding, collaboration, and staff support were key considerations for DPP adoption. Providers were supportive of DPP features; however, there was concern from both stakeholders on retention in a 16-week program. Both groups cited transportation, cost, and health insurance reimbursement as existing barriers to the uptake of these programs. Conclusion This qualitative study highlights important considerations for scaling up diabetes prevention programs in community settings, including what constraints agencies face in adopting programs, the perceived demand and programmatic needs for these services by customers, and the need for improving patient education on prediabetes. This implementation science study allows us to increase the potential to scale up and sustain diabetes prevention programs that fit available resources and customer needs. [ABSTRACT FROM AUTHOR]