Protocol of a study to evaluate a lifestyle intervention during pregnancy

Abstract Background The risk of developing obesity and chronic diseases (e.g. diabetes mellitus) in children is influenced by the mother's lifestyle during pregnancy (prenatal programming). This study evaluates a computer-assisted preventive lifestyle counseling carried out during prenatal visits and infant check-ups. GeMuKi (acronym for 'strengthening health promotion: enhanced check-up visits for mother and child') is a complex intervention consisting of multiple components implemented by different cooperating healthcare providers. Methods GeMuKi supplements regular prenatal visits and infant check-ups with an additional counseling regarding physical activity, nutrition and alcohol and tobacco use. Providers, who carry out the counseling, receive communication training using motivational interviewing techniques. Pregnant women in 4 intervention regions in Germany receive GeMuKi from gynecologists, midwives and pediatricians, while participants in the 4 control regions receive standard care. As part of a hybrid effectiveness-implementation trial with 1860 participants, questionnaires are filled in at 4 time points. Weight development and health data of the mother and child are recorded. Health services use will be analyzed using statutory health insurance claims data. Interviews will be conducted to evaluate the implementation process. Results Targeted preventive measures at the beginning of pregnancy intend to reduce the risk of inadequate gestational weight gain (primary outcome). Secondary endpoints are amongst others maternal lifestyle, infant weight development and body composition. Conclusions GeMuKi is set up as a long-term, low-threshold, multimodal intervention in living environments and existing structures. Findings will add to the evidence on lifestyle interventions during pregnancy to reduce the risk for overweight and obesity. Results will contribute to the prevention of early programming of chronic disease and will inform decisions about scale up and public funding. Key messages Lifestyle interventions provided from the beginning of pregnancy intent to be beneficial for the health of both mother and child to prevent obesity and chronic diseases. Low-threshold interventions embedded in regular prenatal visits are accessible for the complete pregnant population, including vulnerable groups.

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A Comprehensive, Multidisciplinary, Personalized, Lifestyle Intervention Program is Associated with Increased Leukocyte Telomere Length in Children and Adolescents with Overweight and Obesity

Nutrients ◽

10.3390/nu13082682 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2682

Author(s):

George Paltoglou ◽

Christina Raftopoulou ◽

Nicolas C. Nicolaides ◽

Sofia M. Genitsaridi ◽

Sofia I. Karampatsou ◽

...

Keyword(s):

Children And Adolescents ◽

Telomere Length ◽

Lifestyle Intervention ◽

Intervention Program ◽

Overweight And Obesity ◽

Initial Assessment ◽

Biological Aging ◽

Childhood And Adolescence ◽

Lifestyle Interventions ◽

Lifestyle Intervention Program

Leucocyte telomere length (LTL) is a robust marker of biological aging and is associated with obesity and cardiometabolic risk factors in childhood and adolescence. We investigated the effect of a structured, comprehensive, multidisciplinary, personalized, lifestyle intervention program of healthy diet and physical exercise on LTL in 508 children and adolescents (239 males, 269 females; 282 prepubertal, 226 pubertal), aged 10.14 ± 0.13 years. Participants were classified as obese (n = 267, 52.6%), overweight (n = 174, 34.2%), or of normal BMI (n = 67, 13.2%) according to the International Obesity Task Force (IOTF) cutoff points and were studied prospectively for one year. We demonstrated that LTL increased significantly after 1 year of the lifestyle interventions, irrespective of gender, pubertal status, or body mass index (BMI). Waist circumference was the best negative predictor of LTL at initial assessment. The implementation of the lifestyle interventions also resulted in a significant improvement in clinical (BMI, BMI z-score and waist to height ratio) and body composition indices of obesity, inflammatory markers, hepatic enzymes, glycated hemoglobin (HbA1C), quantitative insulin sensitivity check index (QUICKI), and lipid profile in all participants. These findings indicate that the increased LTL may be associated with a more favorable metabolic profile and decreased morbidity later in life.

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The ‘loneliness pandemic’: implications for gerontological nursing

British Journal of Nursing ◽

10.12968/bjon.2021.30.11.652 ◽

2021 ◽

Vol 30 (11) ◽

pp. 652-655

Author(s):

Carlos Laranjeira

Keyword(s):

Mental Health ◽

Older Adults ◽

Older People ◽

Chronic Diseases ◽

Old Age ◽

Social Isolation ◽

Social Relationships ◽

Vulnerable Groups ◽

Negative Consequences ◽

Gerontological Nursing

The COVID-19 pandemic compelled states to limit free movement, in order to protect at-risk and more vulnerable groups, particularly older adults. Due to old age or debilitating chronic diseases, this group is also more vulnerable to loneliness (perceived discrepancy between actual and desired social relationships) and social isolation (feeling that one does not belong to society). This forced isolation has negative consequences for the health of older people, particularly their mental health. This is an especially challenging time for gerontological nursing, but it is also an opportunity for professionals to combat age stereotypes reinforced with COVID-19, to urge the measurement of loneliness and social isolation, and to rethink how to further adjust interventions in times of crisis, such as considering technology-mediated interventions in these uncertain times.

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Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review

Obesity Reviews ◽

10.1111/j.1467-789x.2010.00740.x ◽

2010 ◽

Vol 11 (12) ◽

pp. 899-906 ◽

Cited By ~ 163

Author(s):

J. C. M. Barte ◽

N. C. W. Ter Bogt ◽

R. P. Bogers ◽

P. J. Teixeira ◽

B. Blissmer ◽

...

Keyword(s):

Systematic Review ◽

Weight Loss ◽

Overweight And Obesity ◽

Lifestyle Interventions

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Targeting and tailoring an intervention for adolescents who are overweight

Nursing Ethics ◽

10.1177/0969733014524761 ◽

2014 ◽

Vol 22 (2) ◽

pp. 237-247 ◽

Cited By ~ 6

Author(s):

Kirsti Riiser ◽

Knut Løndal ◽

Yngvar Ommundsen ◽

Nina Misvær ◽

Sølvi Helseth

Keyword(s):

Health Behavior ◽

Ethical Issues ◽

Public Health Intervention ◽

Well Being ◽

Health Behavior Change ◽

Overweight And Obesity ◽

Ethical Framework ◽

Vulnerable Groups ◽

Attribution Of Responsibility ◽

Ethical Aspects

There are important ethical issues to be examined before launching any public health intervention, particularly when targeting vulnerable groups. The aim of this article is to identify and discuss ethical concerns that may arise when intervening for health behavior change among adolescents identified as overweight. These concerns originate from an intervention designed to capacitate adolescents to increase self-determined physical activity. Utilizing an ethical framework for prevention of overweight and obesity, we identified three ethical aspects as particularly significant: the attribution of responsibility for health behavior, liberty to choose, and the effect on the participants’ psychosocial well-being. It is discussed whether and how measures can be taken to deal with these aspects. It seems evident that the ethical aspects are mainly concerned with the vulnerability of adolescents identified as overweight. However, we claim that when individual feedback and counseling is provided, tailored interventions have a unique potential to empower adolescents to make ethically anchored decisions about their own health behavior.

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Citizen workshops in public libraries to disseminate and discuss primary care research results: a scaling-up study

10.21203/rs.3.rs-136811/v1 ◽

2020 ◽

Author(s):

José Massougbodji ◽

Hervé Tchala Vignon Zomahoun ◽

Evehouenou Lionel Adisso ◽

Jasmine Sawadogo ◽

Valérie Borde ◽

...

Keyword(s):

Knowledge Translation ◽

Financial Incentives ◽

General Public ◽

Large Scale ◽

Public Libraries ◽

Scale Up ◽

Scaling Up ◽

Computer Assisted ◽

Knowledge Gain ◽

Research Results

Abstract Background Little is known about engaging patients and stakeholders in the process of scaling up effective knowledge translation interventions targeting the general public. Using an integrated knowledge translation approach, we aimed to scale up and evaluate an effective pilot program of disseminating research results in public libraries. Methods We conducted a scaling-up study targeting the general public. Based on our successful pilot project, we co-developed and implemented a larger-scale program of free citizen workshops in public libraries, this time in close research partnership with stakeholders and patient representatives. Citizen workshops, each facilitated by one participating physician and one science communicator, consisted of a 45-min computer-assisted presentation and a 45-min open exchange. Additional scale-up costs included offering financial incentives to stakeholders involved and the purchase of audio-visual equipment. The intervention outcome was knowledge gained. Scale-up outcomes were satisfaction, appropriateness, coverage, time and costs. An evaluation questionnaire was used to collect data of interest. Both quantitative and qualitative analyses were performed. Results The workshop theme chosen by patient and stakeholder representatives was the high prevalence of medication overuse among people over 65 years of age. From April to May 2019, 26 workshops were given in 25 public libraries reaching 362 people. Eighteen participating physicians and six science communicators facilitated the workshops. Participants reported significant knowledge gain (mean difference 2.1, 95% CI 2.0–2.2, P < .001). Median score for overall public satisfaction was 9/10 (IQR 8–10). A high level of appropriateness of the workshops was globally rated by the public participants Coverage was 92.6% of the total number of public libraries targeted. Costs were $6,051.84 CAD for workshop design and $22,935.41 CAD for scaling them up. Conclusion This project successfully established a large-scale and successful KT bridge between researchers, clinicians, and citizens via public libraries. This study provides a model for a dissemination practice that benefits the general public by both engaging them in the dissemination process and by targeting them directly.

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LIVING AND HEALTH CONDITIONS ASSOCIATED WITH OVERWEIGHT AND OBESITY AMONG ELDERLY

Journal of Frailty & Aging ◽

10.14283/jfa.2015.55 ◽

2015 ◽

pp. 1-9

Author(s):

B.F. DO NASCIMENTO JACINTO DE SOUZA ◽

L. MARÍN-LEON

Keyword(s):

Chronic Diseases ◽

Eating Behaviors ◽

Multinomial Logistic Regression ◽

The Elderly ◽

Cross Sectional Study ◽

Overweight And Obesity ◽

Related Factors ◽

Cross Sectional ◽

Increased Risk ◽

Health Related

Background: The epidemiological and nutritional transition processes in the last decades underlie the rising trend of obesity in the elderly and is related to increased risk of chronic non-communicable diseases and decreased functional status. Objective: To analyze the association of demographic, socioeconomic, lifestyle and health-related factors with overweight and obesity in elderly. Design: Cross-sectional study. Setting: Carried out in Campinas-São Paulo, Brazil, in 2011. Participants: 452 non-institutionalized elderly (aged ≥60 years), half were users of a government-run soup kitchen and the other half were neighbors of the same sex. Results:Overweight frequency (BMI ≥25 and <30 kg/m2) was 44.5% and obesity (BMI ≥30 kg/m2) was 21.7%. In the multiple multinomial logistic regression model adjusted for sex, age group and economic class, there was greater chance of overweight among those that reported dyslipidemia; those that reported arthritis/ arthrosis/rheumatism and that once or more per week replaced supper by a snack were more likely to be obese. Elderly who did not leave home daily and reported diabetes had higher chance of overweight and obesity. Conclusions: Overweight and obesity are associated with worse living and health-related conditions, such as physical inactivity, changes in eating behaviors, and chronic diseases. Public health policies should encourage regular physical activity and healthy eating behaviors, focusing on traditional diet, through nutritional education, in order to reduce the prevalence of overweight and obesity and chronic diseases.

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Effectiveness of Lifestyle Interventions for Prevention of Harmful Weight Gain among Adolescents from Ethnic Minorities: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176059 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6059

Author(s):

Nematullah Hayba ◽

Samiha Elkheir ◽

Jessica Hu ◽

Margaret Allman-Farinelli

Keyword(s):

Ethnic Minorities ◽

Transition To Adulthood ◽

Vegetable Intake ◽

Overweight And Obesity ◽

Racial Group ◽

Lifestyle Interventions ◽

Z Score ◽

Randomized Controlled ◽

Secondary Outcomes ◽

Adolescent Period

The escalating obesity among adolescents is of major concern, especially among those from an ethnic minority background. The adolescent period offers a key opportunity for the implementation of positive lifestyle behaviours as children transition to adulthood. The objective of this review was to examine the effectiveness of lifestyle interventions for adolescents and their impact in ethnic and racial minorities for the prevention of overweight and obesity. Seven electronic databases were searched from 2005 until March 2019 for randomized controlled trials of lifestyle programs conducted in this population. The main outcome was change in Body Mass Index (BMI) z-score (kg/m2) or change in BMI and secondary outcomes were changes in physical activity and diet. Thirty studies met the inclusion criteria. Seven studies reported and/or conducted subgroup analysis to determine if ethnic/racial group affected weight change. None demonstrated an overall decrease in BMI z-score. However, six of the seven demonstrated changes in secondary measures such as fruit and vegetable intake and screen time. Results did not differ by ethnic/racial group for primary and secondary outcomes. Overweight and obesity prevention among adolescents from ethnic minorities is an area that needs further research. There is a lack of interventions that include analyses of effectiveness in ethnic minorities.

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A review of the use of information and communication technologies for dietary assessment

British Journal Of Nutrition ◽

10.1017/s0007114509990638 ◽

2009 ◽

Vol 101 (S2) ◽

pp. S102-S112 ◽

Cited By ~ 113

Author(s):

Joy Ngo ◽

Anouk Engelen ◽

Marja Molag ◽

Joni Roesle ◽

Purificación García-Segovia ◽

...

Keyword(s):

Information And Communication Technologies ◽

Dietary Assessment ◽

Age Groups ◽

Communication Technologies ◽

Digital Photography ◽

Smart Cards ◽

Vulnerable Groups ◽

Personal Digital Assistants ◽

Computer Assisted ◽

Information And Communication

Presently used dietary-assessment methods often present difficulties for researchers and respondents, and misreporting errors are common. Methods using information and communication technologies (ICT) may improve quality and accuracy. The present paper presents a systematic literature review describing studies applying ICT to dietary assessment. Eligible papers published between January 1995 and February 2008 were classified into four assessment categories: computerised assessment; personal digital assistants (PDA); digital photography; smart cards. Computerised assessments comprise frequency questionnaires, 24 h recalls (24HR) and diet history assessments. Self-administered computerised assessments, which can include audio support, may reduce literacy problems, be translated and are useful for younger age groups, but less so for those unfamiliar with computers. Self-administered 24HR utilising computers yielded comparable results as standard methods, but needed supervision if used in children. Computer-assisted interviewer-administered recall results were similar to conventional recalls, and reduced inter-interviewer variability. PDA showed some advantages but did not reduce underreporting. Mobile phone meal photos did not improve PDA accuracy. Digital photography for assessing individual food intake in dining facilities was accurate for adults and children, although validity was slightly higher with direct visual observation. Smart cards in dining facilities were useful for measuring food choice but not total dietary intake. In conclusion, computerised assessments and PDA are promising, and could improve dietary assessment quality in some vulnerable groups and decrease researcher workload. Both still need comprehensive evaluation for micronutrient intake assessment. Further work is necessary for improving ICT tools in established and new methods and for their rigorous evaluation.

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Multicomponent Lifestyle Interventions for Treating Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analyses

Journal of Obesity ◽

10.1155/2017/5021902 ◽

2017 ◽

Vol 2017 ◽

pp. 1-14 ◽

Cited By ~ 13

Author(s):

I. K. Ø. Elvsaas ◽

L. Giske ◽

B. Fure ◽

L. K. Juvet

Keyword(s):

Systematic Review ◽

Children And Adolescents ◽

Group Treatment ◽

Overweight And Obesity ◽

Lifestyle Interventions ◽

Significant Difference ◽

Subgroup Analyses ◽

Specialist Health Care ◽

Moderate Effect ◽

Meta Analyses

Background. Treatment of childhood obesity is important in preventing development of obesity-related diseases later in life. This systematic review evaluates the effect of multicomponent lifestyle interventions for children and adolescents from 2 to 18 years.Methods and Results. We performed systematic searches in nine databases. Thirty-nine studies met the criteria for meta-analyses. We found a significant difference in body mass index (BMI) after 6 months (MD −0.99 (95% CI −1.36 to −0.61)), 12 months (MD −0.67 (95% CI −1.01 to −0.32)), and 24 months (MD −0.96 (95% CI −1.63 to −0.29)) in favour of multicomponent lifestyle interventions compared to standard, minimal, and no treatment. We also found a significant difference in BMIZscores after 6 months (MD −0.12 (95% CI −0.17 to −0.06)), 12 months (MD −0.16 (95% CI −0.21 to −0.11)), and 24 months (MD −0.16 (95% CI −0.21 to −0.10)) in favour of multicomponent lifestyle interventions. Subgroup analyses suggested an increased effect in specialist health care with a group treatment component included in the intervention.Conclusion. Multicomponent lifestyle interventions have a moderate effect on change in BMI and BMIZscore after 6, 12, and 24 months compared with standard, minimal, and no treatment.

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Obesity: criteria and classification

Proceedings of The Nutrition Society ◽

10.1017/s0029665100000732 ◽

2000 ◽

Vol 59 (4) ◽

pp. 505-509 ◽

Cited By ~ 88

Author(s):

F. Xavier Pi-Sunyer

Keyword(s):

Waist Circumference ◽

Body Fat ◽

Genetic Predisposition ◽

Overweight And Obesity ◽

The Body ◽

Upper Body ◽

Anthropometric Measurement ◽

Computer Assisted ◽

Computer Assisted Tomography ◽

The Individual

Obesity is defined as an excess accumulation of body fat. To measure fat in the body accurately is difficult, and no method is easily available for routine clinical use. Traditionally, overweight and obesity have been evaluated by anthropometric measurement of weight-for-height. More recently, BMI has been used. The normal range is 19–24·9 kg/m2, overweight is 25–29·9 kg/m2, and obesity ≥ 30 kg/m2. Not only is the total amount of fat an individual carries important, but also where the fat is distributed in the body. Fat in a central or upper body (android) distribution is most related to health risk. The most accurate way to measure central obesity is by magnetic resonance imaging or computer-assisted tomography scanning, but this approach is too expensive for routine use. Simple anthropometric measurements can be used, such as waist circumference. A waist circumference of greater than 1020 mm in men and 880 mm in women is a risk factor for insulin resistance, diabetes mellitus and cardiovascular disease. There is a clear genetic predisposition for obesity. The genetic contribution to obesity is between 25 and 40 % of the individual differences in BMI. For the overwhelming majority of individuals, the genetic predisposition will not be defined by one gene, but by multiple genes. Eventually, classification of obesity may be done by genetic means, but this approach will require more knowledge.

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