Post on 30-Mar-2015
Modifying Obesogenic Homes: Impact on Weight Maintenance
NHLBIHL077082
Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan
Project Staff: Kimberley Chula Maguire (Project Director), Erica Ferguson, Jen Trautvetter, Dylan
Wykes, Elizabeth Jackvony, Pam Coward, Melissa Crane, Mike Gutierrez, Jill Donnelly
Obesity Trends Among U.S. Adults2005
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
(BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
Health Impact of Excessive Weight
CVD
Diabetes
Gallbladder disease
Respiratory disease
Arthritis
Cancer________________________
$60+ billion in direct medical costs and 100,000+ deaths each year
Behavioral Weight Control
Antecedents Behavior Consequences
– Self-monitoring– Stimulus control– Problem solving– Social support– Goal setting– Cognitive restructuring– Relapse prevention
Modest weight losses (5-10% of body weight) and increases in physical activity can decrease the risk of diabetes and other health problems by more than 50%
The Good News…
The Bad News…
0
2
4
6
8
10
12
14
1M 3M 6M 1Y 5Y
Pe
rce
nta
ge
re
du
cti
on
in in
itia
l we
igh
t
Treatment Follow-up
TIME IN WEEKS
Wadden et al., 1989
An Ecological Model of Obesity(NHLBI)
HealthOutcomes
En
erg
yB
alan
ce
Behaviors
EatingDietary patterns,nutrient intake
Sedentary Behaviors
TV, computer use,driving
Physical Activity
Recreation,transportation,
occupation,domestic
Weight, Fat, &
Distribution
Risk Factors,CVD,
Diabetes,Cancers,
Costs
Influences
Biological & DemographicAge, sex, race/ethnicity, SES, genes
PsychologicalBeliefs, preferences, emotions, self-efficacy, intentions,
pros, cons, behavior change skills, body image, motivation, knowledge
Social/CulturalSocial support, modeling, family factors, social norms,
cultural beliefs, acculturation
Physical EnvironmentAccess to & quality of foods, recreational facilities, cars,
sedentary entertainment; urban design, transportation infrastructure, information environment
Policies/IncentivesCost of foods, physical activities, & sedentary behaviors;
incentives for behaviors; regulation of environments
OrganizationalPractices, programs, norms, & policies in schools, worksite,
Health care settings, businesses, community orgs
Developed for the NHLBI Workshop on Predictors of Obesity, Weight Gain, Diet, and Physical Activity; August 4-5, 2004, Bethesda MD
An Ecological Model of Obesity(NHLBI)
HealthOutcomes
En
erg
yB
alan
ce
Behaviors
EatingDietary patterns,nutrient intake
Sedentary Behaviors
TV, computer use,driving
Physical Activity
Recreation,transportation,
occupation,domestic
Weight, Fat, &
Distribution
Risk Factors,CVD,
Diabetes,Cancers,
Costs
Influences
Biological & DemographicAge, sex, race/ethnicity, SES, genes
PsychologicalBeliefs, preferences, emotions, self-efficacy, intentions,
pros, cons, behavior change skills, body image, motivation, knowledge
Social/CulturalSocial support, modeling, family factors, social norms,
cultural beliefs, acculturation
Physical EnvironmentAccess to & quality of foods, recreational facilities, cars,
sedentary entertainment; urban design, transportation infrastructure, information environment
Policies/IncentivesCost of foods, physical activities, & sedentary behaviors;
incentives for behaviors; regulation of environments
OrganizationalPractices, programs, norms, & policies in schools, worksite,
Health care settings, businesses, community orgs
Developed for the NHLBI Workshop on Predictors of Obesity, Weight Gain, Diet, and Physical Activity; August 4-5, 2004, Bethesda MD
Overweight and obese (BMI 25-50 kg/m2) adults randomly assigned to 18 months of:
1) standard behavioral treatment
2) SBT + direct manipulation of physical and social home environment
Goal 1: Modify the type and portion sizes of foods consumed in the home
• Alter food cues in the home• Cabinet Cleanouts and Filling up with Fit Foods• Subscription to healthy eating magazine• Motivational posters
• Control portions of meals consumed in home• Serving size appropriate plates and glasses
• Food provision via Peapod• In pilot study, this decreased % of high fat foods in the
home from 27% to 17%, significantly more than SBT
Goal 2: Modify the availability of exercise equipment and sedentary activities
in the home
• Provision of treadmill or exercise bike
• Enhancing visual cues for exercise• Subscription to exercise magazine• Motivational posters
• Decreasing cues for sedentary activity• Limiting access to TVs with TV Allowance• In pilot, reduced household TV time by 50%
Goal 3: Increase the saliency of the consequences of eating and exercise
choices
• Provided with digital scale and full length mirror
• Instructed to place items in prominent locations in home
Goal 4: Create a positive model for healthy eating and exercise in the home
• Required to bring an overweight, adult partner who lives in the same house to treatment
• Partner sets weight loss goal and makes similar changes in eating and exercise– Based on prior work showing
that bringing a partner is only effective when the partner is also successful
LEAP Study Outcomes• Participants and partners assessed at 0, 6, 12,
and 18 m;
– Weight
– Weight-related behaviors• Dietary intake • Physical activity• TV viewing
– Other variables• Depression• Quality of life• Reasons for wanting to lose weight• Alcohol use and smoking
Assessing the Home Environment
Physical home environment
– Type and placement of food– Type and placement of
exercise equipment– # of TVs – TV in the bedroom– Scale, full length mirror– Healthy eating and exercise
magazines
Social home environment
– Type of support (autonomous vs. controlled) from partner
– Household support – how supportive each person is of participant’s weight control efforts and whether or not they are interested in changing their own eating and exercise
– Sallis Support Measure
Home visits at 0, 6, and 18 m
Study Progress
• Recruitment
201 pairs (402 individuals) enrolled in the study
50.5+10.8 years78.6% women21.4% minority participation
• Retention
97% at 6 m 89% at 12 m95% at 18 m (2 out of 6 waves completed)