1) 95% of participants in a two-year weight loss study were willing to pay for continued lifestyle intervention, with a median monthly amount of $45, similar to commercial programs.
2) Black participants were willing to pay more ($65/month) than non-Black participants. Weight loss success did not impact willingness to pay.
3) The order that payment options were presented influenced willingness to pay amounts, with lower initial options yielding lower reported maximum payments.
Dietary Strategies for Weight Loss MaintenanceMARKETDIGITALBN
Weight regain after a successful weight loss intervention is very common. Most studies
show that, on average, the weight loss attained during a weight loss intervention period is not
or is not fully maintained during follow-up. We review what is currently known about dietary
strategies for weight loss maintenance, focusing on nutrient composition by means of a systematic
review and meta-analysis of studies and discuss other potential strategies that have not been studied
so far. Twenty-one studies with 2875 participants who were overweight or obese are included in
this systematic review and meta-analysis
Application of Binary Logistic Regression Model to Assess the Likelihood of O...sajjalp
Abstract: This study attempts to assess the likelihood of overweight and associated factors among the young students by analyzing their physical measurements and physical activity index. This paper has classified four hundred and fifteen subjects and precisely estimated the likelihood of outcome overweight by combining body mass index and CUN-BAE calculated. Multicollinearity is tested with multiple regression analysis. Box-Tidwell Test is used to check the linearity of the continuous independent variables and their logit (log odds). The binary regression analysis was executed to determine the influences of gender, physical activity index, and physical measurements on the likelihood that the subjects fall in overweight category. The sensitivity and specificity described by the model are 55.9% and 96.9% respectively. The increase in the value of waist to height ratio and neck circumference and drop in physical activity index are associated with the increased likelihood of subjects falling to overweight group. The prevalence of overweight is higher (27.8%) in female than in male (14.7%) subjects. The odds ratio for gender reveals that the likelihood of subjects falling to overweight category is 2.6 times higher in female compared to male subjects.
Keywords: Overweight, Waist to Height Ratio, Neck Circumference, Binary Logistic Model, Odds Ratio
Dietary Strategies for Weight Loss MaintenanceMARKETDIGITALBN
Weight regain after a successful weight loss intervention is very common. Most studies
show that, on average, the weight loss attained during a weight loss intervention period is not
or is not fully maintained during follow-up. We review what is currently known about dietary
strategies for weight loss maintenance, focusing on nutrient composition by means of a systematic
review and meta-analysis of studies and discuss other potential strategies that have not been studied
so far. Twenty-one studies with 2875 participants who were overweight or obese are included in
this systematic review and meta-analysis
Application of Binary Logistic Regression Model to Assess the Likelihood of O...sajjalp
Abstract: This study attempts to assess the likelihood of overweight and associated factors among the young students by analyzing their physical measurements and physical activity index. This paper has classified four hundred and fifteen subjects and precisely estimated the likelihood of outcome overweight by combining body mass index and CUN-BAE calculated. Multicollinearity is tested with multiple regression analysis. Box-Tidwell Test is used to check the linearity of the continuous independent variables and their logit (log odds). The binary regression analysis was executed to determine the influences of gender, physical activity index, and physical measurements on the likelihood that the subjects fall in overweight category. The sensitivity and specificity described by the model are 55.9% and 96.9% respectively. The increase in the value of waist to height ratio and neck circumference and drop in physical activity index are associated with the increased likelihood of subjects falling to overweight group. The prevalence of overweight is higher (27.8%) in female than in male (14.7%) subjects. The odds ratio for gender reveals that the likelihood of subjects falling to overweight category is 2.6 times higher in female compared to male subjects.
Keywords: Overweight, Waist to Height Ratio, Neck Circumference, Binary Logistic Model, Odds Ratio
Efficacy of interventions to increase physical activity for people with heart...AliyaAmirova1
Key questions
What is already known about this subject?
Individuals diagnosed with heart failure (HF) are advised to engage in physical activity. However, physical activity levels remain extremely low in this population group. Cardiac rehabilitation (CR) is routinely offered to newly diagnosed HF patients. CR is multifaceted; It is unknown which specific components result in physical activity improvements once the programme has ended. It is essential to understand how best to improve everyday physical activity engagement in HF.
What does this study add?
This meta-analysis assessed what constitutes a successful physical activity intervention designed for individuals living with HF. The findings pinpoint specific intervention features and components that contribute to physical activity improvements in HF. Centre-based interventions that are delivered by a physiotherapist, in group format, which combine exercise with behavioural change intervention are promising for attaining physical activity improvements.
How might this impact on clinical practice?
The findings of this meta-analysis may inform physical activity intervention designed for individuals diagnosed with HF. There is a need for additional training for physiotherapists in delivering behavioural change interventions alongside an exercise programme that includes the identified efficacious strategies.
Quality Lowers Cost: The Cost Effectiveness of a Multicenter Treatment Bundle for Severe Sepsis and Septic Shock By: Lydia Dong MD, MS; Intermountain Healthcare - Intensive Medicine Clinical Programs
Presented at the 11th Annual HSR/ PCOR Conference: Partnering for Better Health: Bringing Utah's Patient Voices to Research 2016
Crimson Publishers - Self-Explanatory Non-Funded Project Study of Dysmenorrhe...CrimsonPublishersDCMP
Self-Explanatory Non-Funded Project Study of Dysmenorrhea and Impact on Quality of Life in Rajgad Dnyanpeeth's College of Pharmacy-Savitribai Phule Pune University Pune by Rahul Hajare* in Developments in Clinical & Medical Pathology
Efficacy of interventions to increase physical activity for people with heart...AliyaAmirova1
Key questions
What is already known about this subject?
Individuals diagnosed with heart failure (HF) are advised to engage in physical activity. However, physical activity levels remain extremely low in this population group. Cardiac rehabilitation (CR) is routinely offered to newly diagnosed HF patients. CR is multifaceted; It is unknown which specific components result in physical activity improvements once the programme has ended. It is essential to understand how best to improve everyday physical activity engagement in HF.
What does this study add?
This meta-analysis assessed what constitutes a successful physical activity intervention designed for individuals living with HF. The findings pinpoint specific intervention features and components that contribute to physical activity improvements in HF. Centre-based interventions that are delivered by a physiotherapist, in group format, which combine exercise with behavioural change intervention are promising for attaining physical activity improvements.
How might this impact on clinical practice?
The findings of this meta-analysis may inform physical activity intervention designed for individuals diagnosed with HF. There is a need for additional training for physiotherapists in delivering behavioural change interventions alongside an exercise programme that includes the identified efficacious strategies.
Quality Lowers Cost: The Cost Effectiveness of a Multicenter Treatment Bundle for Severe Sepsis and Septic Shock By: Lydia Dong MD, MS; Intermountain Healthcare - Intensive Medicine Clinical Programs
Presented at the 11th Annual HSR/ PCOR Conference: Partnering for Better Health: Bringing Utah's Patient Voices to Research 2016
Crimson Publishers - Self-Explanatory Non-Funded Project Study of Dysmenorrhe...CrimsonPublishersDCMP
Self-Explanatory Non-Funded Project Study of Dysmenorrhea and Impact on Quality of Life in Rajgad Dnyanpeeth's College of Pharmacy-Savitribai Phule Pune University Pune by Rahul Hajare* in Developments in Clinical & Medical Pathology
TouchPapua adalah organisasi nirlaba yang mendesain, mengimplementasikan dan mempromosikan proyek-proyek yang mempunyai dampak langsung terhadap masyarakat akar rumput Papua.
RESEARCH Open AccessTelecoaching plus a portion control pl.docxsyreetamacaulay
RESEARCH Open Access
Telecoaching plus a portion control plate
for weight care management: a
randomized trial
Jill M. Huber1, Joshua S. Shapiro2, Mark L. Wieland1, Ivana T. Croghan1, Kristen S. Vickers Douglas3,
Darrell R. Schroeder4, Julie C. Hathaway5 and Jon O. Ebbert1,6*
Abstract
Background: Obesity is a leading preventable cause of death and disability and is associated with a lower health-
related quality of life. We evaluated the impact of telecoaching conducted by a counselor trained in motivational
interviewing paired with a portion control plate for obese patients in a primary care setting.
Methods: We conducted a randomized, clinical trial among patients in a primary care practice in the midwestern
United States. Patients were randomized to either usual care or an intervention including telecoaching with a
portion control plate. The intervention was provided during a 3-month period with follow-up of all patients
through 6 months after randomization. The primary outcomes were weight, body mass index (BMI),waist
circumference, and waist to hip ratio measured at baseline, 6, 12, 18, and 24 weeks. Secondary outcomes included
measures assessing eating behaviors, self-efficacy, and physical activity at baseline and at 12 and 24 weeks.
Results: A total of 1,101 subjects were pre-screened, and 90 were randomly assigned to telecoaching plus portion
control plate (n = 45) or usual care (n = 45). Using last-value carried forward without adjustment for baseline
demographics, significant reductions in BMI (estimated treatment effect -0.4 kg/m2, P = .038) and waist to hip ratio
(estimated treatment effect -.02, P = .037) at 3 months were observed in the telecoaching plus portion control plate
group compared to usual care. These differences were not statistically significant at 6 months. In females, the
telecoaching plus portion control plate intervention was associated with significant reductions in weight and BMI
at both 3 months (estimated treatment effect -1.6 kg, P = .016 and -0.6 kg/m2, P = .020) and 6 months (estimated
treatment effect -2.3 kg, P = .013 and -0.8 kg/m2, P = .025). In males, the telecoaching plus portion control
intervention was associated with a significant reduction in waist to hip ratio at 3 months (estimated treatment
effect -0.04, P = .017), but failed to show a significant difference in weight and BMI.
Conclusion: Telecoaching with a portion control plate can produce positive change in body habitus among obese
primary care patients; however, changes depend upon sex.
Trial registration: ClinicalTrials.gov NCT02373878, 13 February 2015. https://clinicaltrials.gov/ct2/show/
NCT02373878.
Keywords: Obesity, Telecoaching, Portion control plate, Primary care, Patient-centered medical home
* Correspondence: [email protected]
1Division of Primary Care Internal Medicine, Department of Medicine,
Rochester, MN 55905, USA
6Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
Full list of author information is ...
American Heart Association Lifestyle Recommendations to Reduce.docxjesuslightbody
American Heart Association Lifestyle Recommendations to Reduce Obesity
Jane Doe
University
Project and Practicum
Summer 2022
Abstract
The prevalence of obesity and sedentary lifestyle complications are increasing at alarming rates, representing a common but preventable cause of severe medical complications like diabetes, cardiovascular diseases, and early mortality. This chronic condition has been for a long time a public health concern and social determinant. The Fitbit app offers a unique opportunity to enhance the efficacy of weight loss plans as it is used to track activity, monitor steps, heart rate, energy expenditure, sleep, and sedentary behavior. The integrative review focused on how the American Heart Association (AHA) Diet and Lifestyle recommendations and the Fitbit app are used as innovative solutions to reduce obesity in adult patients.
Research Methodology: A systematic review was conducted to identify research articles completed in the preceding 4-5 years centered on obesity care, diet, physical activity, activity trackers, and lifestyle implications.
Results and Discussion: The databases searched were Chamberlain Library, PubMed, and CINHAL. Initial searches yielded over 2000 articles, of which 45 were chosen and examined because they fit the integrative review's theme. The 15 papers most relevant to the PICOT question were studied in further detail and appraised using the Johns Hopkins Evidence Appraisal table. The studies reported positive physical activity outcomes.
Conclusions and Further Recommendations:This systematic review supported the effectiveness of the AHA Diet and Lifestyle recommendations to reduce obesity, and clinical use generalization is recommended. Fitbit app provides new ways to improve physical activity habits, and the easy availability of electronic devices may enhance their generalizability use.
Keywords: Obesity care; Obesity complications; Lifestyle recommendations; Obesity management; Physical activity intervention using Fitbit activity trackers.
Dedication
Thanks to my family for their unwavering support of this project; their cooperation means a lot to me. To my husband Armando, thank you for your love, understanding, and patience during this time. I credit my achievement to all of you for your unwavering love and belief in me.
Acknowledgments
First, I must acknowledge the help of all my professors who inspired, encouraged, and supported me throughout the DNP program. My heartfelt thanks to my teammates, without whom I would never have completed this phase in my life. Their encouragement has had a significant influence on my strong determination during this trip.
Contents
American Heart Association Lifestyle Recommendations to Reduce Obesity 1
Abstract 2
Introduction Error! Bookmark not defined.
Dedication 3
Acknowledgments 4
American Heart Association Lifestyle Recommendations to Reduce Obesity 6
Problem Statement 6
S.
This webinar will discuss the prevalence of pre-diabetes and it’s contributing factors and the initial efforts to translate the National Diabetes Prevention Program to public health. We will also look at new approaches to providing interventions.
Learning objectives:
Scope and scale of pre-diabetes and what factors contribute to it.
Review initial efforts to translate the DPP to public health.
New approaches to providing interventions.
About The Presenter
Dr. Marrero received a B.A. (1974), M.A. (1978) and Ph.D. (1982) in Social Ecology from the University of California, Irvine. He joined the IU School of Medicine in 1984 and became the J.O. Ritchey Professor of Medicine in 2004. He was a member of the Diabetes Research & Training Center and served as Director of the Diabetes Prevention and Control Division. He is currently the Director of the Diabetes Translational Research Center. Dr. Marrero is an expert in the field of clinical trails in diabetes and translation research which moves scientific advances obtained in clinical trails into the public health sector. He helped design the Diabetes Prevention Program and the TRIAD study, which evaluated strategies to improve diabetes care delivery in managed care settings. His research interests include strategies for promoting diabetes prevention, care settings, improving diabetes care practices used by primary care providers, and the use of technology to facilitate care and education. Dr. Marrero was twice awarded the Allene Von Son Award for Diabetes Patient Education Tools by the American Association of Diabetes Educators, nominated to Who’s Who in Medicine and Health care in 2000, served as Associate Editor for Diabetes Care (1997-2002) and is currently the Associate Editor for Diabetes Forecast. He was selected as Alumni of the Year for University of California Irvine in 2006 and The Outstanding Educator in Diabetes in 2008 by the American Diabetes Association. He is the current President of the American Diabetes Association.
American Heart Association Lifestyle Recommendations to Redu.docxSusanaFurman449
American Heart Association Lifestyle Recommendations to Reduce Obesity
Yuritza Medina
Chamberlain College of Nursing
NR709 Project and Practicum IV
Summer 2022
Abstract Past tense
The prevalence of obesity and sedentary lifestyle complications are increasing at alarming rates, representing a common but preventable cause of severe medical complications like diabetes, cardiovascular diseases, and early mortality. This common but chronic condition has been for a long time a public health concern and social determinant. The integrative review focused on how the American Heart Association (AHA) Diet and Lifestyle recommendations and the Fitbit app are used as innovative solutions to reduce obesity in adult patients. The Fitbit app offers a unique opportunity to enhance the efficacy of weight loss plans, as it is used to track activity, monitor steps, heart rate, energy expenditure, sleep, and sedentary behavior.
Research Methodology: A systematic review was conducted to identify research articles completed in the preceding 4-5 years centered on obesity care, diet, physical activity, activity trackers, and lifestyle implications. The databases searched were Chamberlain Library, PubMed, and CINHAL.
Results and Discussion: Initial searches yielded over 2000 articles, of which 45 were chosen and examined because they fit the integrative review's theme. The 15 papers most relevant to the PICOT question were studied in further detail and appraised using the Johns Hopkins Evidence Appraisal table. The studies reported positive physical activity outcomes. What were the key themes?
Conclusions and Further Recommendations:This systematic review supported the effectiveness of the AHA Diet and Lifestyle recommendations to prevent and reduce obesity, and clinical use is recommended. Fitbit app provides new ways to improve physical activity habits, and the easy availability of electronic devices may enhance their generalizability use.
Keywords: Obesity care; Obesity complications; Lifestyle recommendations; Obesity management; Physical activity intervention using Fitbit activity trackers.
Dedication
In dedication to my family for their steadfast support of this project; their cooperation means a lot to me. To my husband Armando, thank you for your love, understanding, and patience during this time. I credit my achievement to all of you for your unwavering love and belief in me.
Acknowledgments
First, I must acknowledge the help of all my professors from Chamberlain University, who inspired, encouraged, and supported me throughout the DNP program. My heartfelt thanks to my teammates, without whom I would never have completed this phase in my life. Their encouragement has had a significant influence on my strong determination during this trip.
Contents
American Heart Association Lifestyle Recommendations to Reduce Obesity 1
Abstract 2
Dedication 3
Acknowledgments 4
Introductio.
School-based physical activity programs for children and adolescents (aged 6 ...Health Evidence™
Health Evidence and Canadian Cochrane Centre hosted a 90 minute webinar on School-based physical activity. This work received support from KT Canada funding from the Canadian Institutes of Health Research (CIHR). Key messages and implications for practice were presented on Wednesday October 30, 2013 at 1:00 pm EST.
This webinar focused on interpreting the evidence in the following review:
Dobbins,M., Husson, H., DeCorby K., & LaRocca, R.L. (2013). School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18. Cochrane Database of Systematic Reviews, 2013(2), Art. No.: CD007651.
Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar.
Comparison of registered and published intervention fidelity assessment in cl...valéry ridde
A methodologically oriented systematic review was conducted to study current practices concerning the assessment of intervention fidelity in CRTs of public health interventions conducted in LMICs.
Tolson, jennifer mental health services and weight loss surgery nfjca v4... (1)William Kritsonis
Dr. William Allan Kritsonis has served as an elementary school teacher, elementary and middle school principal, superintendent of schools, director of student teaching and field experiences, professor, author, consultant, and journal editor. Dr. Kritsonis has considerable experience in chairing PhD dissertations and master thesis and has supervised practicums for teacher candidates, curriculum supervisors, central office personnel, principals, and superintendents. He also has experience in teaching in doctoral and masters programs in elementary and secondary education as well as educational leadership and supervision. He has earned the rank as professor at three universities in two states, including successful post-tenure reviews.
Alive pd protocol and descriptive paperGladys Block
Alive-PD is a fully automated tailored diabetes prevention program. This journal article describes its features, and describes the protocol of the randomized controlled trial.
Diabetic Care
Lanetra Evans-Shelton
Walden University
Nursing 6052- Dr. Smith
Essentials of Evidence-Based Practice
Diabetic Care
Introduction
The organization I am affiliated with is a correctional facility. It houses over 300 detainees with some being newly diagnosed diabetics. The officers need training because the facility doesn’t have 24-hour nursing and they are responsible for letting the detainees check their blood sugar levels at night and providing snacks. There is increasing interest in quality improvement strategies to improve diabetic management.
The purpose is to provide ongoing preventive care through new activities which will allow us to identify and interfere in the advancement of diabetes while in jail.
The current problem is over half the time the nurses are unaware of the people who have diabetes unless they puts in a medical request which sometimes takes days. The jail has an intake process of getting booked into jail but does not have a medical intake process. And that’s a big change that needs to happen. The stakeholders who needs to be part of the design and implementation for it to make a difference are the quorum courts, the Sherriff, and the Jail’s Chief Administrator. The risk associated with the change is jail administration have no standard strategies to follow when implementing something new..
Proposal
Patients with a diagnosis of diabetes should have a complete medical history and physical examination by a licensed health care team member in a timely manner. Goals should be individualized depending on the situation. This should be documented in the patient's record and communicated to all persons involved in his/her care, including security staff.
The necessity of the change must be acknowledged and acceptable. Staff must be trained for the new procedures. A training curriculum must explain the role, its technical procedures, its strengths and weaknesses, legal requirements, and professional relationship standards. The success of this project prompts conversation with the major, chief and the sheriff. With the organizational adaption and staff involvement the implementation of the change should be successful (Melnyk & Fineout-Overholt, 2018).
People with diabetes should obtain care that meets national standards. Being incarcerated does not change these standards. Patients must have right to medication and nutrition needs to manage their disease. In patients who do not meet treatment goals, medical and behavioral plans should be adjusted by health care providers in collaboration with the prison staff (Worswick, Wayne, Bennett, Fiander, Mayhew, Weir, & Grimshaw, 2013).
It is critical for correctional facilities to identify patients in need of more intensive evaluation and therapy, including pregnant women, patients with advanced complications, a history of repeated severe hypoglycemia, or recurrent DKA (ADA, 2011).
Outcomes
Critical Appraisal Summary
Diet and physical activity ...
Telehealth methods to deliver dietary interventions in adults .docxjohniemcm5zt
Telehealth methods to deliver dietary interventions in adults with
chronic disease: a systematic review and meta-analysis1,2
Jaimon T Kelly,3 Dianne P Reidlinger,3 Tammy C Hoffmann,4 and Katrina L Campbell3,5*
3
Faculty of Health Sciences and Medicine,
4
Centre for Research in Evidence Based Practice, Bond University, Gold Coast, Australia; and
5
Nutrition and
Dietetics Department, Princess Alexandra Hospital, Brisbane, Australia
ABSTRACT
Background: The long-term management of chronic disease re-
quires the adoption of complex dietary recommendations, which
can be facilitated by regular coaching to support behavioral changes.
Telehealth interventions can overcome patient-centered barriers to
accessing face-to-face programs and provide feasible delivery methods,
accessible regardless of geographic location.
Objective: This systematic review assessed the effectiveness of
telehealth dietary interventions at facilitating dietary change in
chronic disease.
Design: A structured systematic search was conducted for all ran-
domized controlled trials evaluating multifactorial dietary interven-
tions in adults with chronic disease that provided diet education in
an intervention longer than 4 wk. Meta-analyses that used the ran-
dom-effects model were performed on diet quality, dietary adher-
ence, fruit and vegetables, sodium intake, energy, and dietary fat
intake.
Results: A total of 25 studies were included, involving 7384
participants. The telehealth dietary intervention was effec-
tive at improving diet quality [standardized mean difference
(SMD): 0.22 (95% CI: 0.09, 0.34), P = 0.0007], fruit and veg-
etable intake [mean difference (MD) 1.04 servings/d (95% CI:
0.46, 1.62 servings/d), P = 0.0004], and dietary sodium intake
[SMD: 20.39 (20.58, 20.20), P = 0.0001]. Single nutrients
(total fat and energy consumption) were not improved by tele-
health intervention; however, after a telehealth intervention, impor-
tant clinical outcomes were improved, such as systolic blood pressure
[MD: 22.97 mm Hg (95% CI: 25.72, 20.22 mm Hg), P = 0.05],
total cholesterol [MD: 20.08 mmol/L (95% CI: 20.16, 20.00 mmol/L),
P = 0.04], triglycerides [MD: 20.10 mmol/L (95% CI: 20.19,
20.01 mmol/L), P = 0.04], weight [MD: 20.80 kg (95% CI:
21.61, 0 kg), P = 0.05], and waist circumference [MD: 22.08 cm
(95% CI: 23.97, 20.20 cm), P = 0.03].
Conclusions: Telehealth-delivered dietary interventions targeting
whole foods and/or dietary patterns can improve diet quality, fruit
and vegetable intake, and dietary sodium intake. When applicable,
they should be incorporated into health care services for people with
chronic conditions. This review was registered at http://www.crd.
york.ac.uk/PROSPERO/ as CRD42015026398. Am J Clin Nutr
2016;104:1693–702.
Keywords: telehealth, diet quality, dietary, diet, fruit, vegetables,
chronic disease
INTRODUCTION
Chronic diseases are the leading cause of ill health, accounting
for .68% of all deaths worldwide (1). Chron.
Telehealth methods to deliver dietary interventions in adults .docxjacqueliner9
Telehealth methods to deliver dietary interventions in adults with
chronic disease: a systematic review and meta-analysis1,2
Jaimon T Kelly,3 Dianne P Reidlinger,3 Tammy C Hoffmann,4 and Katrina L Campbell3,5*
3
Faculty of Health Sciences and Medicine,
4
Centre for Research in Evidence Based Practice, Bond University, Gold Coast, Australia; and
5
Nutrition and
Dietetics Department, Princess Alexandra Hospital, Brisbane, Australia
ABSTRACT
Background: The long-term management of chronic disease re-
quires the adoption of complex dietary recommendations, which
can be facilitated by regular coaching to support behavioral changes.
Telehealth interventions can overcome patient-centered barriers to
accessing face-to-face programs and provide feasible delivery methods,
accessible regardless of geographic location.
Objective: This systematic review assessed the effectiveness of
telehealth dietary interventions at facilitating dietary change in
chronic disease.
Design: A structured systematic search was conducted for all ran-
domized controlled trials evaluating multifactorial dietary interven-
tions in adults with chronic disease that provided diet education in
an intervention longer than 4 wk. Meta-analyses that used the ran-
dom-effects model were performed on diet quality, dietary adher-
ence, fruit and vegetables, sodium intake, energy, and dietary fat
intake.
Results: A total of 25 studies were included, involving 7384
participants. The telehealth dietary intervention was effec-
tive at improving diet quality [standardized mean difference
(SMD): 0.22 (95% CI: 0.09, 0.34), P = 0.0007], fruit and veg-
etable intake [mean difference (MD) 1.04 servings/d (95% CI:
0.46, 1.62 servings/d), P = 0.0004], and dietary sodium intake
[SMD: 20.39 (20.58, 20.20), P = 0.0001]. Single nutrients
(total fat and energy consumption) were not improved by tele-
health intervention; however, after a telehealth intervention, impor-
tant clinical outcomes were improved, such as systolic blood pressure
[MD: 22.97 mm Hg (95% CI: 25.72, 20.22 mm Hg), P = 0.05],
total cholesterol [MD: 20.08 mmol/L (95% CI: 20.16, 20.00 mmol/L),
P = 0.04], triglycerides [MD: 20.10 mmol/L (95% CI: 20.19,
20.01 mmol/L), P = 0.04], weight [MD: 20.80 kg (95% CI:
21.61, 0 kg), P = 0.05], and waist circumference [MD: 22.08 cm
(95% CI: 23.97, 20.20 cm), P = 0.03].
Conclusions: Telehealth-delivered dietary interventions targeting
whole foods and/or dietary patterns can improve diet quality, fruit
and vegetable intake, and dietary sodium intake. When applicable,
they should be incorporated into health care services for people with
chronic conditions. This review was registered at http://www.crd.
york.ac.uk/PROSPERO/ as CRD42015026398. Am J Clin Nutr
2016;104:1693–702.
Keywords: telehealth, diet quality, dietary, diet, fruit, vegetables,
chronic disease
INTRODUCTION
Chronic diseases are the leading cause of ill health, accounting
for .68% of all deaths worldwide (1). Chron.
Telehealth methods to deliver dietary interventions in adults .docx
WTP-2015-Obesity
1. Willingness to Pay for Continued Delivery of a Lifestyle-Based
Weight Loss Program: The Hopkins POWER Trial
Gerald J. Jerome1,2
, Reza Alavi2
, Gail L. Daumit2,3
, Nae-Yuh Wang2,3
, Nowella Durkin2
, Hsin-Chieh Yeh2,3
,
Jeanne M. Clark2,3
, Arlene Dalcin2
, Janelle W. Coughlin4
, Jeanne Charleston2,3
, Thomas A. Louis5
, and Lawrence J. Appel2,3
Objective: In behavioral studies of weight loss programs, participants typically receive interventions free
of charge. Understanding an individual’s willingness to pay (WTP) for weight loss programs could be
helpful when evaluating potential funding models. This study assessed WTP for the continuation of a
weight loss program at the end of a weight loss study.
Methods: WTP was assessed with monthly coaching contacts at the end of the two-year Hopkins
POWER trial. Interview-administered questionnaires determined the amount participants were willing to
pay for continued intervention. Estimated maximum payment was calculated among those willing to pay
and was based on quantile regression adjusted for age, body mass index, race, sex, household income,
treatment condition, and weight change at 24 months.
Results: Among the participants (N 5 234), 95% were willing to pay for continued weight loss interven-
tion; the adjusted median payment was $45 per month. Blacks had a higher adjusted median WTP ($65/
month) compared to Non-Blacks ($45/month), P 5 0.021.
Conclusions: A majority of participants were willing to pay for a continued weight loss intervention with
a median monthly amount that was similar to the cost of commercial weight loss programs.
Obesity (2015) 23, 282–285. doi:10.1002/oby.20981
Introduction
In behavioral studies of weight loss programs, participants typically
receive interventions free of charge. Understanding individuals’ will-
ingness to pay (WTP) can be helpful when evaluating funding mod-
els that include member contributions. Few studies have examined
WTP for obesity treatment. Three reports were surveys of the gen-
eral population and included references to hypothetical treatments
(1-3). Another study surveyed those in a 10-year bariatric surgery
study and referenced an unspecified treatment that would address
their weight problems (4).
One of the only studies to determine WTP among individuals cur-
rently in a lifestyle-based weight loss program found participants
were willing to pay $1324 (Canadian, 2004) for a hypothetical
three-month lifestyle based weight loss program that included physi-
cian counseling every 2 weeks (5). WTP was lower ($787 Canadian)
for a hypothetical program that included group meetings but no phy-
sician involvement. Roux et al. noted that the hypothetical program
with physician involvement, although preferred, was unrealistic and
that the other program with group counseling more closely matched
services currently available in the community (5).
In the current study, we report WTP for a continued weight loss
program at the end of a 24-month study among participants who
were randomized to the active intervention groups in the Hopkins
POWER trial, a three-arm randomized weight loss trial that enrolled
1
Department of Kinesiology, Towson University, Towson, Maryland, USA. Correspondence: Gerald J. Jerome (gjerome@towson.edu) 2
Division of
General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 3
Welch Center for Prevention, Epidemiology, and
Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA 4
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, Maryland, USA 5
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,
USA.
Funding agencies: Supported by a grant from the National Heart, Lung, and Blood Institute (HL087085) and Healthways Inc.
Disclosure: Healthways, Inc. developed the intervention website used in the POWER trial in collaboration with Johns Hopkins investigators and provided coaching effort
for the remotely delivered intervention. Healthways also provided some research funding to supplement NIH support. Under an institutional consulting agreement with
Healthways, the Johns Hopkins University received fees for advisory services to Healthways during the POWER trial. Faculty members who participated in the consulting
services received a portion of the university fees. On the basis of POWER trial results, Healthways developed and is commercializing a weight-loss intervention program
called InnergyTM
. Under an agreement with Healthways, Johns Hopkins faculty monitor the Innergy program’s content and process (staffing, training, and counseling) and
outcomes (engagement and weight loss) to ensure consistency with the corresponding arm of the POWER trial. Johns Hopkins receives fees for these services, and
faculty members who participate in the consulting services receive a portion of these fees. Johns Hopkins receives royalty on sales of the Innergy program. No other
potential conflict of interest relevant to this article was reported.
Author contributions: All authors were involved in writing the paper and had final approval of the published version.
Received: 5 August 2014; Accepted: 27 October 2014; Published online 31 December 2014. doi:10.1002/oby.20981
282 Obesity | VOLUME 23 | NUMBER 2 | FEBRUARY 2015 www.obesityjournal.org
Brief Cutting Edge Report
CLINICAL TRIALS: BEHAVIOR, PHARMACOTHERAPY, DEVICES, SURGERY
Obesity
2. a demographically heterogeneous study population (6,7). The study
also examined differences in WTP among demographic groups and
groups based on 24-month weight change.
Methods
Overview
The POWER trial at Hopkins was a randomized trial examining the
effectiveness of two lifestyle-based weight loss interventions
(n 5 277) compared to a control group (n 5 138) among obese adult
patients at six primary care practices (6,7). Participants were 22
years of age, body mass index (BMI) 30 kg/m2
, with additional
cardiovascular risk factor(s). WTP for continued lifestyle program-
ming was assessed at month 24 follow-up among participants in
both active intervention arms. An institutional review board
approved the study, and all participants provided written informed
consent. Study details have been published (6,7) A brief description
follows.
Intervention summary
Participants assigned to the two lifestyle interventions with a 5%
weight loss goal and access to a study website that included learning
modules and tools for self-monitoring weight, caloric intake, and
exercise. During the first six months, the Remote Support Only
(RSO) participants were offered 15 coaching calls and the In-Person
Support (IPS) participants were offered 21 group sessions and 9
individual coaching sessions (in-person or by telephone). From
months 7–24, RSO participants were offered monthly calls and IPS
participants were offered both individual and group sessions
monthly.
TABLE 1 Willingness to pay for continued lifestyle-based weight loss program by demographic, treatment condition, and
weight change categories
Amount willing to pay ($/month)
Not willing to pay Willing to pay Crude median Adjusted median
Characteristics n (%) n (%) Median [Q1, Q3] Median [Q1, Q3] P
Total 11 (5) 223 (95) 40 [20, 100] 45 [28, 83]
Age (years)
55 4 (36) 102 (46) 40 [20, 100] 50 [34, 83] 0.371
55 7 (64) 121 (54) 40 [20, 65] 45 [28, 83] Ref
Baseline BMI (kg/m2
)
BMI 35 8 (73) 110 (49) 40 [20, 100] 50 [28, 91] 0.385
BMI 35 3 (27) 113 (51) 40 [20, 65] 45 [28, 83] Ref
Race
Black 2 (18) 88 (39) 40 [20, 100] 65 [34, 100] 0.021
Non-Black 9 (82) 135 (61) 40 [20, 65] 45 [28, 83] Ref
Sex
Female 10 (91) 135 (61) 40 [20, 100] 40 [28, 83] 0.433
Male 1 (9) 88 (39) 40 [20, 100] 45 [28, 83] Ref
Household income (annual)
$50,000 1 (9) 48 (22) 40 [20, 65] 30 [18, 74] 0.107
$50,000–99,999 5 (45) 81 (36) 40 [20, 100] 45 [22, 83] 0.136
$100,000 5 (45) 94 (42) 40 [20, 65] 45 [28, 83] Ref
Treatment condition
Remote support only 5 (45) 115 (52) 40 [20, 100] 35 [22, 74] 0.111
In-person support 6 (55) 108 (48) 40 [20, 100] 45 [28, 83] Ref
Weight change (24 months)
baseline weight 3 (27) 51 (23) 40 [20, 65] 45 [28, 83] Ref
5% weight loss 5 (45) 73 (33) 40 [20, 100] 55 [38, 74] 0.268
5% weight loss 3 (27) 98 (44) 40 [20, 100] 55 [32, 83] 0.210
Order of cost options presented
Low First 6 (55) 70 (31) 20 [20, 40] 25 [16, 40] 0.002
Middle First 2 (18) 64 (29) 40 [20, 100] 45 [26, 74] 1.00
High First 3 (27) 89 (40) 40 [20, 100] 45 [28, 83] Ref
Note: Estimates are adjusted for all variables listed. P values indicated within-group differences in adjusted medians for each characteristic. Ref indicates reference for
within-group test.
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www.obesityjournal.org Obesity | VOLUME 23 | NUMBER 2 | FEBRUARY 2015 283
3. Primary outcome
As previously reported, at 24 months, the control arm loss 20.8 kg,
RSO loss 24.6 kg (P 0.001 compared to control), and IPS loss
25.1 kg (P 0.001 compared to control) with no significant differ-
ence between RSO and IPS (6). At month 24, 40% of the intervention
participants (n5 105) achieved 5% weight loss. At month 24, 40% of
the intervention participants (n5 105) achieved 5% weight loss.
Willingness to pay measures
Participants were asked by an interviewer whether they would be will-
ing to pay to remain in the weight loss program if they could continue
with monthly coaching contact. If a participant indicated a WTP, then
they were asked if they were willing to pay various amounts ($10/
month; $20/month; $40/month; $65/month; and $100/month) until a
maximum amount was identified. Three algorithms were implemented
in an alternating sequence. The low algorithm started with $10 per
month then inquired about the next higher amount; the middle algo-
rithm started with $40 per month and worked in an ascending or
descending order based on participant response; and the high algorithm
started with $100 per month then inquired about lesser amounts.
Analyses
Among those willing to pay for the service (i.e., WTP $0), quartiles
(Q1, Q2, Q3) for the maximum amount willing to pay were reported in
US dollars per month. Estimated maximum payment ($/month) quartiles
(Q1, Q2, Q3) were based on quantile regression and adjusted for each of
the following categorical variables: age (55 and 55 years); BMI
(35 and 35 kg/m2
); race (Black and Non-Black); sex (female and
male); household income ($50,000; $50,000-$99,999; and
$100,000); treatment condition (RSO and IPS); weight change at 24
months ( baseline weight; 5% weight loss; 5% weight loss); and
initial cost presented (low initial cost, middle initial cost, high initial
cost).
Results
Among the 277 participants in the active intervention groups, 13
were missing weight data, and an additional 31 were missing WTP
data. Hence, 234 participants were included in these analyses.
Among those who indicated a WTP (n 5 223) 46% were younger
than 55 years of age, 50% had a BMI below 35 kg/m2
at baseline,
39% were Black, and 61% were female. Table 1 reports the crude
median amount participants were willing to pay (median 5 40) and
[Q1 5 20, Q3 5 100].
The adjusted medians [Q1, Q3] were calculated using a single quan-
tile regression analyses that included all categorical variables listed
and the quartiles reported are adjusted for all variables in the model.
The overall adjusted median was $45 per month. There was a statis-
tically significant difference between the medianadj WTP of Blacks
($65/month) and Non-Blacks ($45/month), P 5 0.021.
The order in which response options were presented was also associ-
ated with WTP; those presented with the lowest amount first (i.e.,
$10/month) had a lower adjusted median payment ($25/month) com-
pared to those who were presented with the highest value first (i.e.,
$100/month) who had a median of $45 per month, P 5 0.002. Nei-
ther weight loss nor income was associated with WTP (P 0.05).
Figure 1 displays the frequency of WTP responses, stratified by the
initial level of payment presented to the participant. The algorithm
that started with the low amount had the highest frequency of
response in the $20/month category (30%) and the algorithm that
started with the high amount had the highest frequency of responses
in the $100/month category (30%).
Discussion
This is one of the first reports on WTP for a specified weight loss pro-
gram after individuals had participated in the program. In the current
study there was strong interest in a sustained intervention with 95% of
participants willing to pay for weight loss program continuation, and an
adjusted median WTP of $45 per month. Black participants were willing
to pay more ($65/month) than Non-Black. Unlike other studies that
found income was associated with WTP, income was not associated
with WTP in the current study (2–4). Interestingly, weight loss success
in the two-year program was not associated with WTP for further serv-
ices. This suggests that even those who were not successful with their
weight goal found value in the program. Perhaps some participants had
personal goals for smaller relative losses or preventing weight gain.
WTP in this study was lower than the amounts reported in previous
studies (e.g., $100-$262/month) which reference hypothetical treat-
ments (2,4,5). It is not clear whether the differences in WTP were
associated with presentation of a hypothetical program versus payment
for a real program well known to participants, or if the characteristics
of the participants were different. It is noteworthy that the median
WTP in our study is similar to advertised prices for commercial pro-
grams (e.g., Weight Watchers online, $42.95/month) (8). Our results
were also similar to the WTP for continued lifestyle-based diabetes
risk-reduction program ($42/month) among those who participated in
a diabetes reduction intervention study (9). The latter study was simi-
lar as it evaluated WTP for a specific lifestyle program at the end of a
study among participants who had been enrolled in the program.
One factor that was associated with WTP was the order in which
responses were presented. Those presented with the lowest cost first
had the lowest median monthly amount. Although there has been
significant discussion regarding how to ask WTP questions, perhaps
the most innovative approach is to actually offer a program at a
given fee and determine who enrolls (5).
We inquired about WTP for monthly coaching and do not know the
WTP for more frequent coaching contact found in the intensive
Figure 1 WTP for continued delivery of a lifestyle-based weight loss program by
order of the initial cost option.
Obesity Willingness to Pay for Lifestyle-Based Weight Loss Jerome et al.
284 Obesity | VOLUME 23 | NUMBER 2 | FEBRUARY 2015 www.obesityjournal.org
4. phase of the program. Although there may have been a ceiling effect
associated with the maximum survey response ($100), a few high
responses would have a minor effect on these results given the use
of medians in the analyses. Moreover, the association among income
and WTP may differ in samples that include more low income par-
ticipants. It should also be noted that missingness in weight loss
studies is likely to be informative. If missing values were replaced
with “unwilling to pay,” then 80% of participants were willing to
pay for continued services. Strengths of the study include a popula-
tion appropriate for a weight loss program, reference to an existing
weight loss program, and a diverse population.
In summary, the vast majority of participants who completed a
weight loss intervention were willing to pay for continuation of the
program, with a median monthly amount that was similar to the cost
of a commercial weight loss program. O
VC 2014 The Obesity Society
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