Background
The COVID‐19 pandemic resulted in mandated stay‐at‐home orders, potentially resulting in changes in mental health (e.g., stress, anxiety) and challenges maintaining healthy dietary and ...physical activity behaviors.
Objective
This study examined how stress was associated with mental well‐being and weight loss behaviors during the COVID‐19 pandemic among adults enrolled in an internet‐based weight loss program.
Methods
Participants enrolled in a weight‐loss program residing in Rhode Island or Massachusetts, USA, completed a brief survey on their mental health and current weight‐loss behaviors during the COVID‐19 pandemic. Surveys were completed between 14 April 2020 and 21 April 2020, approximately one month after stay‐at‐home orders were mandated. Linear regression was used to examine associations between stress, mental health, and weight‐loss behaviors.
Results
A total of 99 participants completed the survey (79% female, 91% white, 52.2 ± 9.8 years, 34.0 ± 5.2 kg/m2, 77% reported moderate to extreme stress). Greater stress was associated with higher BMI (p = 0.04), higher education (p = 0.04), working more hours (p = 0.003), and having school‐age children at home (p = 0.002). Greater stress was also associated with higher levels of anxiety, worry, and concern regarding COVID‐19 (p's < 0.001) and having less time to spend on weight‐loss efforts (p < 0.001), after controlling for BMI and education.
Conclusions
Many individuals enrolled in a weight‐loss program experienced more stress during COVID‐19 compared to before the pandemic. This stress was related to more mental health challenges as well as more difficulties finding time for weight management efforts.
To explore barriers and facilitators to healthy eating during the COVID-19 pandemic among adults enrolled in an internet-based weight loss program.
Adults in an internet-delivered weight loss program ...were recruited to participate. Participants completed online study surveys and a semi-structured interview via telephone between June 1, 2020 and June 22, 2020. The interview included questions to explore how the COVID-19 pandemic has influenced dietary behaviors. Constant comparative analysis was used to identify key themes.
Participants (n = 30) were primarily female (83%) and white (87%), 54.6 ± 10.0 years old, and had a mean body mass index of 31.1 ± 4.5 kg/m
2
. Barriers included snacking/ease of access to food, eating as a coping mechanism, and lack of routine/planning. Facilitators included calorie control, regular routine/scheduling, and self-monitoring. General themes with eating were a change in eating out frequency or modality, cooking more, and changes in alcohol consumption.
Eating habits among adults enrolled in a weight loss program changed during the COVID-19 pandemic. Future weight loss programs and public health recommendations should consider modifying recommendations to place increased emphasis on strategies to overcome barriers to healthy eating and promote facilitators that may help with healthy eating, particularly during unexpected circumstances or events.
The purposes of this study were to develop a new measure, the Facilitators and Barriers to Physical Activity Scale for People with Mental Illness (FBPAS-MI) and to validate the psychometrics.
This ...study included two phases. In Phase I, a literature review and five focus groups were conducted to develop an item bank. Then, expert consultation and cognitive interviews were used for content validity. In Phase II, 147 participants with severe mental illness were recruited from 10 community-based psychiatric rehabilitation centers in Taiwan to examine the psychometrics. Principal axis factoring method with direct oblique rotation was used to identify the underlying constructs of FBPAS-MI. Concurrent validity, internal consistency and test-retest reliability were examined.
The results revealed five domains in the facilitator subscale (15 items) and two domains in the barrier subscale (11 items). Both subscales showed satisfactory internal consistency (all Cronbach's α >0.80); the concurrent validity and test-retest reliability were established.
This study confirmed that the FBPAS-MI is a valid and reliable scale to understand perceived facilitators and barriers to physical activity for severe mental illness. The FBPAS-MI can provide useful information in the development of individualized health promotion program for this population.
Implications for Rehabilitation
The Facilitators and Barriers to Physical Activity Scale for People with Mental Illness (i.e., FBPAS-MI) is a valid and reliable assessment to examine key factors affecting physical activity participation among people with severe mental illness.
Psychiatric rehabilitation practitioners could use the FBPAS-MI to help develop and tailor individualized physical activity promotion programs based on identified facilitators and barriers to activity.
Weight reduction programs are not generally designed or adapted for people with physical disabilities. This study examined the effect of a 9-months remote, telephone-based weight management program ...for people with physical disabilities using a Web-based system (Personalized Online Weight and Exercise Response System POWERS).
A total of 102 participants (mean ± SD age, 46.5 ± 12.7 yrs; body mass index, 32.0 ± 5.8 kg/m(2)) with a physical disability (spinal cord injury, multiple sclerosis, spina bifida, cerebral palsy, stroke, or lupus) were randomized to one of three conditions: physical activity only (POWERS), physical activity plus nutrition (POWERS(plus)), and control. The POWERS group received a physical activity tool kit and regular coaching telephone calls. The POWERS(plus) group received an intervention identical to that of the POWERS group plus nutritional information. The control group received the physical activity tool kit and self-guided health promotion resources at the completion of the trial but no coaching.
Postintervention differences in body weight were found between the groups. There was a significant group × time interaction (P < 0.01) in postintervention body weight, with both the POWERS and POWERS(plus) groups demonstrating greater reduction in body weight compared with the control group (POWERS: -2.1 ± 5.5 kg, -2.4 ± -5.9%; POWERS(plus): -0.5 ± 5.0 kg, -0.6 ± 4.3%; control: +2.6 ± 5.3 kg, 3.1 ± 7.4%).
A low-cost telephone intervention supported with a Web-based remote coaching tool (POWERS) can be an effective strategy for assisting overweight adults with physical disabilities in maintaining or reducing their body weight.
Abstract Background Obesity-attributable medical expenditures remain high, and interventions that are both effective and cost-effective have not been adequately developed. The Opt-IN study is a ...theory-guided trial using the Multiphase Optimization Strategy (MOST) to develop an optimized, scalable version of a technology-supported weight loss intervention. Objective Opt-IN aims to identify which of 5 treatment components or component levels contribute most meaningfully and cost-efficiently to the improvement of weight loss over a 6 month period. Study design Five hundred and sixty obese adults (BMI 30–40 kg/m2 ) between 18 and 60 years old will be randomized to one of 16 conditions in a fractional factorial design involving five intervention components: treatment intensity (12 vs. 24 coaching calls), reports sent to primary care physician (No vs. Yes), text messaging (No vs. Yes), meal replacement recommendations (No vs. Yes), and training of a participant's self-selected support buddy (No vs. Yes). During the 6-month intervention, participants will monitor weight, diet, and physical activity on the Opt-IN smartphone application downloaded to their personal phone. Weight will be assessed at baseline, 3, and 6 months. Significance The Opt-IN trial is the first study to use the MOST framework to develop a weight loss treatment that will be optimized to yield the best weight loss outcome attainable for $500 or less.
Objectives
Greater dietary self‐monitoring adherence is associated with weight loss, however, the dietary self‐monitoring adherence criteria that predict weight loss are unknown. The criteria used to ...define adherence to dietary self‐monitoring in obesity treatment tend to vary, particularly in studies that include dietary self‐monitoring via mobile applications (apps). The objectives of this study were to (a) determine weight change outcomes related to app‐based dietary self‐monitoring and (b) determine the associations between the frequency, consistency, and completeness of dietary self‐monitoring and weight change.
Methods
In this single‐arm uncontrolled prospective study, employees at a large, urban health system who had overweight or obesity self‐monitored dietary intake for 8 weeks using the Calorie Counter by FatSecret app. A paired sample t‐test examined the association of app‐based dietary self‐monitoring and weight change; linear regression examined the associations of frequent, consistent, and complete dietary self‐monitoring and weight change.
Results
A significant mean difference t (89) = 6.59, p < 0.001 was found between baseline and 8‐week weight (M = −1.5 ± 2.1 kg) in the sample (N = 90). Linear regression revealed a significant association F (1, 88) = 7.18, p = 0.009 between total weeks of consistent dietary self‐monitoring (M = 4.4 ± 2.8) and percent weight loss (M = −1.54% ± 2.26%), and a significant association F (1, 88) = 6.42, p = 0.013 between dietary self‐monitoring frequency (M = 50.1% ± 33.3%) and percent weight loss. The total weeks of complete dietary self‐monitoring (M = 3.42 ± 2.87) was not associated F (1, 88) = 3.57, p = 0.062 with percent weight loss.
Conclusions
Consistent and frequent app‐based dietary self‐monitoring were associated with short‐term weight loss. Emphasizing these aspects of self‐monitoring may be an avenue for decreasing the burden of self‐monitoring.
Arthritis is a leading cause of chronic pain and functional limitations. Exercise is beneficial for improving strength and function and decreasing pain. We evaluated the effect of a motivational ...interviewing-based lifestyle physical activity intervention on self-reported physical function in adults with knee osteoarthritis (KOA) or rheumatoid arthritis (RA).
Participants were randomized to intervention or control. Control participants received a brief physician recommendation to increase physical activity to meet national guidelines. Intervention participants received the same brief baseline physician recommendation in addition to motivational interviewing sessions at baseline, 3, 6, and 12 months. These sessions focused on facilitating individualized lifestyle physical activity goal setting. The primary outcome was change in self-reported physical function. Secondary outcomes were self-reported pain and accelerometer-measured physical activity. Self-reported KOA outcomes were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for KOA (WOMAC scores range from 0 to 68 for function and 0 to 20 for pain) and the Health Assessment Questionnaire (HAQ) for RA. Outcomes were measured at baseline, 3, 6, 12, and 24 months. Multiple regression accounting for repeated measures was used to evaluate the overall intervention effect on outcomes controlling for baseline values.
Participants included 155 adults with KOA (76 intervention and 79 control) and 185 adults with RA (93 intervention and 92 control). Among KOA participants, WOMAC physical function improvement was greater in the intervention group compared to the control group difference = 2.21 (95% CI: 0.01, 4.41). WOMAC pain improvement was greater in the intervention group compared to the control group difference = 0.70 (95% CI: −0.004, 1.41). There were no significant changes in physical activity. Among RA participants, no significant intervention effects were found.
Participants with KOA receiving the lifestyle intervention experienced modest improvement in self-reported function and a trend toward improved pain compared to controls. There was no intervention effect for RA participants. Further refinement of this intervention is needed for more robust improvement in function, pain, and physical activity.
Objective
We examined the accuracy of data from an affordable personal monitor (Fitbit Flex) compared with that of data from a research‐grade accelerometer worn simultaneously for 7 days; high ...accuracy would support substitution with this less‐expensive personal activity monitor in future community‐based arthritis research.
Methods
Subjects (N = 35) with chronic knee symptoms were recruited for a pilot intervention study using Fitbits to increase physical activity in employees with chronic knee symptoms at an urban corporation. Subjects simultaneously wore for 7 days a Fitbit Flex (wrist‐worn) and ActiGraph GT3X+ (waist‐worn). Fitbit Flex data were regularly stored on a research storage service (Fitabase) by participants. Bland–Altman plots were constructed to examine the agreement between the mean daily times spent in light activity and in bouted moderate‐to‐vigorous physical activity (MVPA). Comparisons were calculated by matching Fitabase data from calendar days the Fitbit was worn with data from valid monitoring days (greater than or equal to 10 hours wear time) of the ActiGraph.
Results
Participants at baseline were mostly female (69%) and white (57%) and had a mean age of 52 years and body mass index of 32 kg/m2. Bland–Altman analyses indicated systematic bias overall (the Fitbit overestimated both light‐intensity activity and MVPA compared with the ActiGraph). The average error varied in magnitude and direction with changing activity amounts.
Conclusion
The Fitbit Flex does not appear to be an adequate substitute for research‐grade accelerometry (which represents the gold standard for objective research monitoring of all physical activity intensity levels) in this population of persons with chronic knee symptoms.
Negative emotional experiences are associated with dysregulated eating behaviors that impede weight management. While weight loss interventions promote physical activity and self-regulation of ...eating, no studies have examined how physical activity may directly influence eating by attenuating associations between negative emotions and eating. Objective: The current study examined how momentary negative emotions (stress and anxiety), moderate-to-vigorous intensity physical activity (MVPA), and their interactions predict eating dysregulation (i.e., intensity of eating temptations, inability to resist eating tempting foods, overeating), as well as how these associations change during a weight loss intervention. Methods: Women with overweight/obesity (N = 55) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after a three-month internet-based weight loss program. Results: Three-way interactions emerged predicting overeating and eating tempting foods. When women experienced higher than usual levels of momentary anxiety or stress at end-of-treatment, they were less likely to subsequently overeat or eat tempting foods when they had recently engaged in more MVPA (relative to their usual level). No significant associations were found for ratings of temptation intensity. Conclusions: Findings suggest MVPA may exert direct effects on eating regulation. Specifically, MVPA appears to increasingly buffer the effect of negative emotional states on dysregulated eating behavior over the course of a weight loss intervention. Future work is needed to develop ways of communicating to patients how activity can have both indirect and direct effects on body weight, and examine whether such knowledge improves outcomes.
To survey Friedman lipid globules by high-resolution histologic examination and to compare with multimodal imaging of hyporeflective caverns in eyes with geographic atrophy (GA) secondary to ...age-related macular (AMD) and other retinal diseases.
Histologic survey of donor eyes with and without AMD. Clinical case series with multimodal imaging analysis.
Donor eyes (n = 139; 26 with early AMD, 13 with GA, 40 with nAMD, 52 with a healthy macula, and 8 with other or unknown characteristics) and 41 eyes of 28 participants with GA (n = 16), nAMD (n = 8), Stargardt disease (n = 4), cone dystrophy (n = 2), pachychoroid spectrum (n = 6), choroidal hemangioma (n = 1), and healthy eyes (n = 4).
Donor eyes were prepared for macula-wide epoxy resin sections through the foveal and perifoveal area. In patients, caverns were identified as nonreflective spaces on OCT images. Multimodal imaging included color and red-free fundus photography; fundus autofluorescence; fluorescein and, indocyanine green angiography; OCT angiography; near-infrared reflectance; and confocal multispectral (MultiColor Spectralis, Heidelberg Engineering, Germany) imaging.
Presence and morphologic features of globules, and presence and appearance of caverns on multimodal imaging.
Globules were found primarily in the inner choroidal stroma (91.0%), but also localized to the sclera (4.9%) and neovascular membranes (2.1%). Mean diameters of solitary and multilobular globules were 58.9±37.8 μm and 65.4±27.9 μm, respectively. Globules showed morphologic signs of dynamism including pitting, dispersion, disintegration, and crystal formation. Evidence for inflammation in the surrounding tissue was absent. En face OCT rendered sharply delimited hyporeflective areas as large as choroidal vessels, frequently grouped around choroid vessels or in the neovascular tissue. Cross-sectional OCT revealed a characteristic posterior hypertransmission. OCT angiography showed absence of flow signal within caverns.
Based on prior literature documenting OCT signatures of tissue lipid in atheroma and nAMD, we speculate that caverns are lipid rich. Globules, with similar sizes and tissue locations in AMD and healthy persons, are candidates for histologic correlates of caverns. The role of globules in chorioretinal physiologic features, perhaps as a lipid depot for photoreceptor metabolism, is approachable through clinical imaging.
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