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Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:

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Presentation on theme: "Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:"— Presentation transcript:

1 Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 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

2 Obesity Trends Among U.S. Adults 2005 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)

3 Health Impact of Excessive Weight CVDDiabetes Gallbladder disease Respiratory disease Arthritis Cancer ________________________ $60+ billion in direct medical costs and 100,000+ deaths each year

4 Behavioral Weight Control Antecedents Behavior Consequences –Self-monitoring –Stimulus control –Problem solving –Social support –Goal setting –Cognitive restructuring –Relapse prevention

5 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…

6 The Bad News… Treatment Follow-up TIME IN WEEKS Wadden et al., 1989

7 An Ecological Model of Obesity (NHLBI) Health Outcomes Energy Balance Behaviors Eating Dietary 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 & Demographic Age, sex, race/ethnicity, SES, genes Psychological Beliefs, preferences, emotions, self-efficacy, intentions, pros, cons, behavior change skills, body image, motivation, knowledge Social/Cultural Social support, modeling, family factors, social norms, cultural beliefs, acculturation Physical Environment Access to & quality of foods, recreational facilities, cars, sedentary entertainment; urban design, transportation infrastructure, information environment Policies/Incentives Cost of foods, physical activities, & sedentary behaviors; incentives for behaviors; regulation of environments Organizational Practices, 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

8 An Ecological Model of Obesity (NHLBI) Health Outcomes Energy Balance Behaviors Eating Dietary 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 & Demographic Age, sex, race/ethnicity, SES, genes Psychological Beliefs, preferences, emotions, self-efficacy, intentions, pros, cons, behavior change skills, body image, motivation, knowledge Social/Cultural Social support, modeling, family factors, social norms, cultural beliefs, acculturation Physical Environment Access to & quality of foods, recreational facilities, cars, sedentary entertainment; urban design, transportation infrastructure, information environment Policies/Incentives Cost of foods, physical activities, & sedentary behaviors; incentives for behaviors; regulation of environments Organizational Practices, 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

9 Overweight and obese (BMI 25-50 kg/m 2 ) adults randomly assigned to 18 months of: 1) standard behavioral treatment 2) SBT + direct manipulation of physical and social home environment

10 Goal 1: Modify the type and portion sizes of foods consumed in the home Alter food cues in the homeAlter food cues in the home Cabinet Cleanouts and Filling up with Fit FoodsCabinet Cleanouts and Filling up with Fit Foods Subscription to healthy eating magazineSubscription to healthy eating magazine Motivational postersMotivational posters Control portions of meals consumed in homeControl portions of meals consumed in home Serving size appropriate plates and glassesServing size appropriate plates and glasses Food provision via PeapodFood provision via Peapod In pilot study, this decreased % of high fat foods in the home from 27% to 17%, significantly more than SBTIn pilot study, this decreased % of high fat foods in the home from 27% to 17%, significantly more than SBT

11 Goal 2: Modify the availability of exercise equipment and sedentary activities in the home Provision of treadmill or exercise bikeProvision of treadmill or exercise bike Enhancing visual cues for exerciseEnhancing visual cues for exercise Subscription to exercise magazineSubscription to exercise magazine Motivational postersMotivational posters Decreasing cues for sedentary activityDecreasing cues for sedentary activity Limiting access to TVs with TV AllowanceLimiting access to TVs with TV Allowance In pilot, reduced household TV time by 50%In pilot, reduced household TV time by 50%

12 Goal 3: Increase the saliency of the consequences of eating and exercise choices Provided with digital scale and full length mirrorProvided with digital scale and full length mirror Instructed to place items in prominent locations in homeInstructed to place items in prominent locations in home

13 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 treatmentRequired 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 exercisePartner 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

14 LEAP Study Outcomes Participants and partners assessed at 0, 6, 12, and 18 m;Participants and partners assessed at 0, 6, 12, and 18 m; –Weight –Weight-related behaviors Dietary intakeDietary intake Physical activityPhysical activity TV viewingTV viewing –Other variables DepressionDepression Quality of lifeQuality of life Reasons for wanting to lose weightReasons for wanting to lose weight Alcohol use and smokingAlcohol use and smoking

15 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 participants 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

16 Study Progress RecruitmentRecruitment 201 pairs (402 individuals) enrolled in the study 50.5+10.8 years 78.6% women 21.4% minority participation RetentionRetention 97% at 6 m 89% at 12 m 95% at 18 m (2 out of 6 waves completed)


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