Health behaviour change considerations for weight loss and type 2 diabetes: nutrition, physical activity and sedentary behaviour

Abstract Background Co-design has the potential to create interventions that lead to sustainable health behaviour change. Evidence suggests application of co-design in various health domains has been growing; however, few public-facing digital interventions have been co-designed to specifically address the needs of adults at risk of Type 2 diabetes (T2D). This study aims to: (1) co-design, with key stakeholders, a digital dietary intervention to promote health behaviour change among adults at risk of T2D, and (2) evaluate the co-design process involved in developing the intervention prototype. Methods The co-design study was based on a partnership between nutrition researchers and designers experienced in co-design for health. Potential end-users (patients and health professionals) were recruited from an earlier stage of the study. Three online workshops were conducted to develop and review prototypes of an app for people at risk of T2D. Themes were inductively defined and aligned with persuasive design (PD) principles used to inform ideal app features and characteristics. Results Participants were predominantly female (range 58–100%), aged 38 to 63 years (median age = 59 years), consisting of a total of 20 end-users and four experts. Participants expressed the need for information from credible sources and to provide effective strategies to overcome social and environmental influences on eating behaviours. Preferred app features included tailoring to the individual’s unique characteristics, ability to track and monitor dietary behaviour, and tools to facilitate controlled social connectivity. Relevant persuasive design principles included social support, reduction (reducing effort needed to reach target behaviour), tunnelling (guiding users through a process that leads to target behaviour), praise, rewards, and self-monitoring. The most preferred prototype was the Choices concept, which focusses on the users’ journey of health behaviour change and recognises progress, successes, and failures in a supportive and encouraging manner. The workshops were rated successful, and feedback was positive. Conclusions The study’s co-design methods were successful in developing a functionally appealing and relevant digital health promotion intervention. Continuous engagement with stakeholders such as designers and end-users is needed to further develop a working prototype for testing.

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How to Maintain a Healthy Body Weight

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.76.4.208 ◽

2006 ◽

Vol 76 (4) ◽

pp. 208-215 ◽

Cited By ~ 10

Author(s):

Astrup

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Weight Loss ◽

Body Weight ◽

Glycemic Index ◽

Dairy Products ◽

Weight Control ◽

Healthy Body Weight ◽

Healthy Body

The epidemic of both obesity and type 2 diabetes is due to environmental factors, but the individuals developing the conditions possess a strong genetic predisposition. Observational surveys and intervention studies have shown that excess body fatness is the major environmental cause of type 2 diabetes, and that even a minor weight loss can prevent its development in high-risk subjects. Maintenance of a healthy body weight in susceptible individuals requires 45–60 minutes physical activity daily, a fat-reduced diet with plenty of fruit, vegetables, whole grain, and lean meat and dairy products, and moderate consumption of calorie containing beverages. The use of table values to predict the glycemic index of meals is of little – if any – value, and the role of a low-glycemic index diet for body weight control is controversial. The replacement of starchy carbohydrates with protein from lean meat and lean dairy products enhances satiety, and facilitate weight control. It is possible that dairy calcium also promotes weight loss, although the mechanism of action remains unclear. A weight loss of 5–10% can be induced in almost all obese patients providing treatment is offered by a professional team consisting of a physician and dieticians or nurses trained to focus on weight loss and maintenance. Whereas increasing daily physical activity and regular exercise does not significantly effect the rate of weight loss in the induction phase, it plays an important role in the weight maintenance phase due to an impact on daily energy expenditure and also to a direct enhancement of insulin sensitivity.

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Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment

Neurology ◽

10.1212/wnl.0000000000003955 ◽

2017 ◽

Vol 88 (21) ◽

pp. 2026-2035 ◽

Cited By ~ 31

Author(s):

Mark A. Espeland ◽

José A. Luchsinger ◽

Laura D. Baker ◽

Rebecca Neiberg ◽

Steven E. Kahn ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Weight Loss ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Lifestyle Intervention ◽

Cognitive Test ◽

Intervention Effect ◽

Intensive Lifestyle Intervention

Objective:To assess whether an average of 10 years of lifestyle intervention designed to reduce weight and increase physical activity lowers the prevalence of cognitive impairment among adults at increased risk due to type 2 diabetes and obesity or overweight.Methods:Central adjudication of mild cognitive impairment and probable dementia was based on standardized cognitive test battery scores administered to 3,802 individuals who had been randomly assigned, with equal probability, to either the lifestyle intervention or the diabetes support and education control. When scores fell below a prespecified threshold, functional information was obtained through proxy interview.Results:Compared with control, the intensive lifestyle intervention induced and maintained marked differences in weight loss and self-reported physical activity throughout follow-up. At an average (range) of 11.4 (9.5–13.5) years after enrollment, when participants' mean age was 69.6 (54.9–87.2) years, the prevalence of mild cognitive impairment and probable dementia was 6.4% and 1.8%, respectively, in the intervention group, compared with 6.6% and 1.8%, respectively, in the control group (p = 0.93). The lack of an intervention effect on the prevalence of cognitive impairment was consistent among individuals grouped by cardiovascular disease history, diabetes duration, sex, and APOE ε4 allele status (all p ≥ 0.50). However, there was evidence (p = 0.03) that the intervention effect ranged from benefit to harm across participants ordered from lowest to highest baseline BMI.Conclusions:Ten years of behavioral weight loss intervention did not result in an overall difference in the prevalence of cognitive impairment among overweight or obese adults with type 2 diabetes.Clinicaltrials.gov identifier:NCT00017953 (Action for Health in Diabetes).Level of evidence:This study provides Class II evidence that for overweight adults with type 2 diabetes, a lifestyle intervention designed to reduce weight and increase physical activity does not lower the risk of cognitive impairment.

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33 - Objectively Measured Physical Activity, Sedentary Behaviour and Cardiometabolic Measures in Adults with Type 2 Diabetes: Results from the Canadian Health Measures Survey (2007-2017)

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2020.08.039 ◽

2020 ◽

Vol 44 (7) ◽

pp. S16

Author(s):

Jane E. Booth ◽

Alexander A. Leung ◽

Jamie L. Benham ◽

Doreen M. Rabi ◽

Gary S. Goldfield ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Sedentary Behaviour ◽

Health Measures ◽

Canadian Health ◽

Objectively Measured ◽

Objectively Measured Physical Activity ◽

Canadian Health Measures Survey

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En Balance: The Contribution of Physical Activity to the Efficacy of Spanish Diabetes Education of Hispanic Americans with Type 2 Diabetes

Journal of Diabetes Research ◽

10.1155/2020/4826704 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Dequina A. Nicholas ◽

Lorena M. Salto ◽

Kristen Lavelle ◽

Joy Wilson ◽

W. Lawrence Beeson ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Weight Loss ◽

Glycemic Control ◽

Education Program ◽

Mexican Americans ◽

Diabetes Education ◽

Fasting Blood Glucose ◽

Active Group

Purpose. En Balance, a culturally sensitive diabetes education program, improves glycemic control in Hispanics with type 2 diabetes. The program emphasized diet, physical activity, and other factors important for glycemic control. However, the individual contributions of these education factors are unclear. The purpose of this study is to assess the contribution of physical activity to the success of En Balance in improving the health of Mexican Americans with type 2 diabetes. Methods. A retrospective study was conducted with plasma samples collected pre- and post-3-month study. Samples from 58 (18 males and 40 females) Hispanic subjects with type 2 diabetes were analyzed for the concentration of kynurenines, known to decrease in response to exercise. After three months, health outcomes for the active group (decreased kynurenines) and the rest of the cohort were evaluated by paired Wilcoxon signed-rank test. Results. Half of the subjects had increased kynurenine levels at the end of the educational program. We found that the subjects in the active group with decreased kynurenine concentrations displayed statistically greater improvements in fasting blood glucose, A1C, cholesterol, and triglycerides despite weight loss being higher in the group with increased kynurenine concentrations. Conclusions. En Balance participants with decreased kynurenine levels had significantly improved glycemic control. These data suggest that physical activity significantly contributes to the success of the En Balance education program. This analysis indicates that diabetes public health educators should emphasize the benefit of physical activity on glycemic control even in the absence of major weight loss.

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Anti-diabetic Treatment in Obese Patients with Type 2 Diabetes Effects of Medication on Body Weight

US Endocrinology ◽

10.17925/use.2006.00.02.1n ◽

2006 ◽

Vol 00 (02) ◽

Author(s):

Andrew J Krentz

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Weight Loss ◽

Vascular Complications ◽

Obese Patients ◽

Intentional Weight Loss ◽

Increased Risk ◽

Potential Benefits ◽

Diabetic Treatment

Obesity is a major risk factor for the development of type 2 diabetes;1–3moreover, the presence of obesity in type 2 diabetes is associated with an increased risk of vascular complications associated with the disorder.4,5The majority of patients are overweight or obese at diagnosis of type2diabetes. Recent clinical trials have demonstrated that progression to diabetes in obese patients with impaired glucose tolerance can be prevented through weight reduction and increased levels of physical activity.6,7For patients who have developed type 2 diabetes, intentional weight loss has many potential benefits including improved metabolic control and a reduced need for antidiabetic medications.8–10

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