modifying obesogenic homes: impact on weight maintenance nhlbi hl077082 investigators: amy gorin...
TRANSCRIPT
![Page 1: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/1.jpg)
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
![Page 2: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/2.jpg)
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)
![Page 3: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/3.jpg)
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
![Page 4: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/4.jpg)
Behavioral Weight Control
Antecedents Behavior Consequences
– Self-monitoring– Stimulus control– Problem solving– Social support– Goal setting– Cognitive restructuring– Relapse prevention
![Page 5: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/5.jpg)
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…
![Page 6: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/6.jpg)
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
![Page 7: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/7.jpg)
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
![Page 8: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/8.jpg)
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
![Page 9: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/9.jpg)
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
![Page 10: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/10.jpg)
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
![Page 11: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/11.jpg)
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%
![Page 12: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/12.jpg)
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
![Page 13: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/13.jpg)
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
![Page 14: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/14.jpg)
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
![Page 15: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/15.jpg)
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
![Page 16: Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff:](https://reader036.vdocument.in/reader036/viewer/2022070306/551920cb5503464a428b4b5b/html5/thumbnails/16.jpg)
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)