The effect of training in reduced energy density eating and food self-monitoring accuracy on weight loss maintenance

Background:
Failure to maintain weight losses in lifestyle change programs continues to be a major problem and warrants investigation of innovative approaches to weight control.
Objective:
The goal of this study was to compare two novel group interventions, both aimed at improving weight loss maintenance, with a control group.
Methods and Procedures:
A total of 103 women lost weight on a meal replacement–supplemented diet and were then randomized to one of three conditions for the 14-week maintenance phase: cognitive-behavioral treatment (CBT); CBT with an enhanced food monitoring accuracy (EFMA) program; or these two interventions plus a reduced energy density eating (REDE) program. Assessments were conducted periodically through an 18-month postintervention. Outcome measures included weight and self-reported dietary intake. Data were analyzed using completers only as well as baseline-carried-forward imputation.
Results:
Participants lost an average of 7.6 plusminus 2.6 kg during the weight loss phase and 1.8 plusminus 2.3 kg during the maintenance phase. Results do not suggest that the EFMA intervention was successful in improving food monitoring accuracy. The REDE group decreased the energy density (ED) of their diets more so than the other two groups. However, neither the REDE nor the EFMA condition showed any advantage in weight loss maintenance. All groups regained weight between 6- and 18-month follow-ups.
Discussion:
Although no incremental weight maintenance benefit was observed in the EFMA or EFMA + REDE groups, the improvement in the ED of the REDE group's diet, if shown to be sustainable in future studies, could have weight maintenance benefits.

Evaluation of an interactive, internet-based weight loss program : a pilot study

The Internet can access a large number of consumers in a more cost-effective manner than other information delivery channels. In this pilot study, we assessed whether an online weight reduction program including dietary advice plus exercise (ED) was more effective in reducing weight than an exercise-only program (EX) >12 weeks. Participants were randomized to either the ED or EX group and attended a center for anthropometric measurements and dietary assessment. Both groups wore a pedometer and set weekly goals to increase daily steps through an interactive Web site. The ED group set weekly dietary goals via the Web site and received tailored e-mail assistance. Seventy-three participants commenced and 53 (73%) completed the study [EX n = 26; ED n = 27; body mass index—mean (standard deviation): 29.7 (2.5) kg m^–2, age 46.3 (10.8); 21% male]. Percent weight changes were EX, 2.1 (0.6)% and ED, 0.9 (0.6)% (P = 0.15). Both groups increased their daily steps with no difference between groups. Only the ED group significantly reduced their energy intake. Despite a greater fall in energy intake reported by the ED group and a similar increase in physical activity in both groups, setting individual dietary goals did not enhance weight loss.

Dietary approaches for weight loss with increased intakes of fruit, vegetables and dairy products

Aim: To assess the effectiveness of specific advice for increasing fruit, vegetable and dairy intake in free-living men participating in a weight loss study.

Methods: Subjects were randomised to one of two 12-week weight loss diets, either the WELL with daily targets of four serves of fruit, four serves of vegetables and three serves of dairy or a low fat diet (LF) with general advice to increase fruit and vegetable intake. Three-day food group diaries and a food frequency questionnaire assessed intake.

Results: Fifty-four overweight/obese male adults completed the study (WELL, n = 27; LF, n = 27; body mass index (mean ± standard deviation), 30.4 ± 2.5 kg/m²; age, 47.7 ± 9.5 years). There was no difference in mean weight change between groups (WELL, −4.8 ± 3.3 kg; LF, −4.6 ± 3.1 kg). Subjects on the WELL diet had greater (mean difference ± standard error) fruit (0.7 ± 0.2 serves/day), vegetable (1.2 ± 0.2 serves/day) and dairy (1.1 ± 0.1 serves/day) intakes than the LF group (measured by the food group diaries) (all P < 0.01). The WELL group reached the daily target for fruit from week 1 (4.7 ± 1.4 serves/day), vegetables by week 6 (4.1 ± 1.5 serves/day) and for dairy by week 8 (3.0 ± 0.8 serves/day).

Conclusions: Providing specific dietary targets to men for weight loss appears to promote greater consumption of fruit, vegetable and dairy foods than providing general dietary advice. Meeting dietary targets appears to require different adjustment periods depending on the food type.

Weight concerns among elementary school children : a review of prevention programs

There is increasing evidence that children display high levels of weight and muscle concerns, which include body dissatisfaction and problem eating. In order to address these issues, researchers have designed and implemented prevention programs for this age group. Thirteen published studies were located and reviewed, with children aged 8–12 years from elementary schools, or equivalent. Overall, the programs were shown to be effective in improving children's knowledge at post-test and at follow-up assessments. However, there is limited evidence to show that the programs reduced or prevented body image concerns and/or problem eating. Too few studies have examined muscle concerns so no conclusions can yet be drawn about this domain. Limitations of the studies and suggestions for future prevention efforts are discussed.

Children's after-school activity : associations with weight status and family circumstance

This study investigated children's after-school activity and associations with body mass index (BMI) and family circumstance. One thousand two hundred thirty-four parents and 854 children (age 8-13 years) completed activity diaries for the 2 hours after school. Parents reported children as more active than children reported themselves. Boys were reported to be more active than girls. Activity levels were generally not associated with BMI or family circumstance with the exception of cultural background. Parent-reported mean child METs were higher for mothers born in Australia (3.3 vs. 3.0; p = .02). Child-reported mean METs were higher for fathers born in Australia (2.9 vs. 2.6; p = .04) and where English was their main language (2.9 vs. 2.3, p = .003).

Is dog ownership or dog walking associated with weight status in children and their parents?

Issue addressed: Several studies have shown that dog owners do more physical activity than non-owners; however, associations with weight status are unknown. This study examined associations between dog ownership, frequency of dog walking and weight status among children and their parents. Methods: Height and weight were measured for 281 children aged 5-6 years and 864 children aged 10-12 years. One parent reported their own and their partner's height and weight (n=1,108), dog ownership, usual frequency their child walks a dog, and usual frequency of walking the dog as a family. Logistic regression analyses were adjusted for sex (children only), physical activity, education, neighbourhood SES, parental weight status (children only) and clustering by school. Results: Dog ownership ranged from 45-57% in the two age groups. Nearly one in four 5-6 year-olds and 37% of 10-12 year- olds walked a dog at least once/week. Weekly dog walking as a family was reported by 24-28% of respondents. The odds of being overweight or obese were lower among younger children who owned a dog (OR=0.5, 95% CI 0.3-0.8) and higher among mothers whose family walked the dog together (OR--1.3, 95% CI 1.0-1.7). Conclusions: Dog ownership may offer some protection from overweight among young children. It is important that families with a dog are encouraged to walk or play with it regularly. Associations with weight status may depend on the type of dog owned, length of ownership and the nature of walks or interaction.

Does weight status influence associations between children's fundamental movement skills and physical activity?

This study sought to determine whether weight status influences the association among children's fundamental movement skills (FMS) and physical activity (PA). Two hundred forty-eight children ages 9-12 years participated. Proficiency in three object-control skills and two locomotor skills was examined. Accelerometers objectively assessed physical activity. Body mass index was calculated to determine weight status. Correlations between physical activity and FMS proficiency were evident among boys and girls. No significant interaction was apparent when examining FMS proficiency scores, PA variables, and weight status. Future studies should examine a broader range of skills and types of activities to better characterize this relationship and to inform the promotion of movement skill proficiency and PA.

Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children : switch-play

Objectives : To evaluate the effectiveness of an intervention to prevent excess weight gain, reduce time spent in screen behaviours, promote participation in and enjoyment of physical activity (PA), and improve fundamental movement skills among children.

Participants : In 2002, 311 children (78% response; 49% boys), average age 10 years 8 months, were recruited from three government schools in low socioeconomic areas of Melbourne, Australia.

Design : Group-randomized controlled trial. Children were randomized by class to one of the four conditions: a behavioural modification group (BM; n=66); a fundamental movement skills group (FMS; n=74); a combined BM/FMS group (BM/FMS; n=93); and a control (usual curriculum) group (n=62). Data were collected at baseline, post intervention, 6- and 12-month follow-up periods.

Results : BMI data were available for 295 children at baseline and 268 at 12-month follow-up. After adjusting for food intake and PA, there was a significant intervention effect from baseline to post intervention on age- and sex-adjusted BMI in the BM/FMS group compared with controls (-1.88 kg m-2, P<0.01), which was maintained at 6- and 12-month follow-up periods (-1.53 kg m-2, P<0.05). Children in the BM/FMS group were less likely than controls to be overweight/obese between baseline and post intervention (adjusted odds ratio (AOR)=0.36, P<0.05); also maintained at 12-month follow-up (AOR=0.38, P<0.05). Compared with controls, FMS group children recorded higher levels and greater enjoyment of PA; and BM children recorded higher levels of PA and TV viewing across all four time points. Gender moderated the intervention effects for participation in and enjoyment of PA, and fundamental movement skills.

Conclusion : This programme represents a promising approach to preventing excess weight gain and promoting participation in and enjoyment of PA. Examination of the mediators of this intervention and further tailoring of the programme to suit both genders is required.

Family physical activity and sedentary environments and weight change in children

Objective. To examine associations between family physical activity and sedentary environment and changes in body mass index (BMI) z-scores among 10-12-year-old children over three years.
Method. Design. Longitudinal (three-year follow-up). Subjects. In total, 152 boys and 192 girls aged 10-12 years at baseline.
Measurements. Measured height and weight at baseline and follow-up (weight status, BMI z-scores); aspects of the family physical activity and sedentary environment (parental and sibling modelling, reinforcement, social support, family-related barriers, rules/restrictions, home physical environment) measured with a questionnaire completed by parents at baseline.
Results. At baseline, 29.6% of boys and 21.9% of girls were overweight or obese, and mean (standard deviation, SD) BMI z-scores were 0.44 (0.99) and 0.28 (0.89), respectively. There was a significant change in BMI z-score among girls (mean change=0.19, SD=0.55, p<0.001), but not boys. Among boys, the number of items at home able to be used for sedentary behaviour (B=0.11, p=0.037) was associated with relatively greater increases in BMI z-score. Among girls, sibling engagement in physical activity at least three times/wk (B=-0.17, p=0.010) and the number of physical activity equipment items at home (B=-0.05, p=0.018) were associated with relatively greater decreases in BMI z-score.
Conclusion. Sibling physical activity and environmental stimuli for sedentary behaviours and physical activity within the home may be important targets for prevention of weight gain during the transition from childhood to adolescence.

Weight status and perception barriers to healthy physical activity and diet behavior

Background : Physical inactivity and insufficient fruit and vegetable consumption are key risk factors for obesity and noncommunicable diseases. Weight perceptions may affect physical activity and diet behaviors. We report current prevalence estimates of Australian adults meeting recommended levels of leisure-time physical activity (LTPA) (150 min/week or more of at least moderate-intensity physical activity (including walking) on 5 days/week) and fruit (2 servings/day) and vegetable (5 servings/day) consumption for health benefits, by weight status and perceptions.
Methods : We conducted a cross-sectional survey analysis of data for 16 314 adults from the Australian National Health Survey 2004–2005. All variables were collected by self-report. Weighted estimates were age- and gender-specific, and data were analyzed using logistic regression with acceptable weight referent categories, adjusting for covariates.
Results : Among acceptable, overweight and obese adults, the prevalence of LTPA was 26.8, 26.1 and 19.3% for men, and 27.7, 23.7 and 19.7% for women, respectively. Approximately 55 and 15% of adults consumed sufficient fruit servings/day and vegetable servings/day, respectively, and less than 5% of adults met combined LTPA and diet guidelines. Overweight decreased the odds ratio for LTPA among women but not men, and obesity decreased the odds ratio for LTPA among both men and women. Overweight perception conferred odds ratios of 0.83 (95% CI 0.70–0.97, P=0.021) for overweight men, and of 0.74 (95% CI 0.62–0.88, P=0.001) and 0.69 (95% CI 0.59–0.80, P<0.001) for obese men and women, respectively; for LTPA, whereas no significant associations were found for acceptable weight perception. No consistent associations between weight status or perceptions and diet behaviors were found.
Conclusions : Overweight perception may be another barrier to physical activity participation among men and women with excess body weight. Public health strategies might need to focus on overcoming weight perception as well as weight status barriers to adopting healthy physical activity behaviors.

Physical activity and healthy weight maintenance from childhood to adulthood

The objective of this study was to determine whether change in physical activity was associated with maintaining a healthy weight from childhood to adulthood. This prospective cohort study examined 1,594 young Australian adults (48.9% female) aged 27–36 years who were first examined at age 9–15 years as part of a national health and fitness survey. BMI was calculated from measured height and weight, and physical activity was self-reported at both time points; pedometers were also used at follow-up. Change in physical activity was characterized by calculating the difference between baseline and follow-up z-scores. Change scores were categorized as decreasing (large, moderate), stable, or increasing (large, moderate). Healthy weight was defined in childhood as a BMI less than international overweight cutoff points, and in adulthood as BMI<25 kg/m2. Healthy weight maintainers were healthy weight at both time points. Compared with those who demonstrated large relative decreases in physical activity, females in all other groups were 25–37% more likely to be healthy weight maintainers, although associations differed according to the physical activity measure used at follow-up and few reached statistical significance. Although younger males whose relative physical activity moderately or largely increased were 27–34% more likely to be healthy weight maintainers than those whose relative physical activity largely decreased, differences were not statistically significant. In conclusion, relatively increasing and stable physical activity from childhood to adulthood was only weakly associated with healthy weight maintenance. Examining personal, social, and environmental factors associated with healthy weight maintenance will be an important next step in understanding why some groups avoid becoming overweight.

Overweight children have poor bone strength relative to body weight, placing them at greater risk for forearm fractures

Introduction: Obesity is thought to be a protective factor for bones in adults but not in children based on the evidence of the greater incidence of forearm fractures in obese children. Our objective was to investigate the effect of adiposity on bone strength in relation to the mechanical challenge placed onto the forearm bones in case of a fall.

Methods: Cross sectional areas (CSA) were obtained at the mid- and distal radius by peripheral quantitative computed tomography in 486 children (241 boys), mean age 8.3 years (range 6.9–9.7), participating in the LOOK Project. The following parameters were measured: bone mass and bone CSA (both sites), and muscle and fat CSA (mid-forearm only). Bone strength indices combining bone size and total volumetric density were calculated at each site.

Results/Discussion: Overweight children (BMI > percentile equivalent to 25 kg/m² in adults) have higher bone parameters than normal-weight peers (Z-scores +0.6 to +0.9SD, p < 0.0001). These differences disappear after adjustment for muscle CSA. Adiposity (fat CSA/muscle CSA) was negatively correlated with bone mass, size and strength at the distal radius only (r = −0.1, p < 0.05). After adjustment for body weight (estimate of the load during a fall), the negative correlations were stronger and observed at both the mid- and distal radius (r = −0.37 to −0.55, p < 0.0001).

Conclusion. Overweight children have stronger bones due to greater muscle size. However, children with high fat mass relative to muscle mass (increased adiposity) have poorer bone strength, independent of weight, which may contribute to the increased risk of fracture in obese children.