%0 Journal Article %J Contemp Clin Trials %D 2013 %T Healthy Homes/Healthy Kids: a randomized trial of a pediatric primary care-based obesity prevention intervention for at-risk 5-10 year olds. %A Sherwood, Nancy E %A Levy, Rona L %A Langer, Shelby L %A Senso, Meghan M %A Crain, A Lauren %A Hayes, Marcia G %A Anderson, Julie D %A Seburg, Elisabeth M %A Jeffery, Robert W %K Accelerometry %K Body Mass Index %K Child %K Child, Preschool %K Cost-Benefit Analysis %K Counseling %K Diet %K Exercise %K Female %K Humans %K Male %K Overweight %K Parent-Child Relations %K Parents %K Pediatric Obesity %K Primary Health Care %K Risk Factors %K Safety %K Sedentary Lifestyle %K Socioeconomic Factors %X

Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a Contact Control condition that focuses on safety and injury prevention. The HHHK 5-10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The Contact Control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5-10 trial.

%B Contemp Clin Trials %V 36 %P 228-43 %8 2013 Sep %G eng %N 1 %R 10.1016/j.cct.2013.06.017 %0 Journal Article %J J Nutr Educ Behav %D 2012 %T Measuring perceived barriers to healthful eating in obese, treatment-seeking adults. %A Welsh, Ericka M %A Jeffery, Robert W %A Levy, Rona L %A Langer, Shelby L %A Flood, Andrew P %A Jaeb, Melanie A %A Laqua, Patricia S %K Body Mass Index %K Diet, Reducing %K Energy Intake %K Factor Analysis, Statistical %K Female %K Health Behavior %K Health Knowledge, Attitudes, Practice %K Humans %K Linear Models %K Male %K Middle Aged %K Obesity %K Perception %K Self Concept %K Self Efficacy %K Surveys and Questionnaires %K Time Factors %K Weight Loss %X

OBJECTIVE: To characterize perceived barriers to healthful eating in a sample of obese, treatment-seeking adults and to examine whether changes in barriers are associated with energy intake and body weight.

DESIGN: Observational study based on findings from a randomized, controlled behavioral weight-loss trial.

PARTICIPANTS: Participants were 113 women and 100 men, mean age 48.8 years, 67% white, and mean body mass index at baseline 34.9 kg/m(2).

VARIABLES MEASURED: Perceived diet barriers were assessed using a 39-item questionnaire. Energy intake was assessed with the Block Food Frequency Questionnaire. Body weight (kg) and height (cm) were measured.

ANALYSIS: Factor-based scales constructed from exploratory factor analysis. Linear regression models regressed 12-month energy intake and body weight on baseline to 12-month factor-based score changes (α = .05).

RESULTS: Exploratory factor analysis yielded 3 factors: lack of knowledge, lack of control, and lack of time. Reported declines in lack of knowledge and lack of control from baseline to 12 months were associated with significantly greater energy restriction over 12 months, whereas reported declines in lack of control and lack of time were associated with significantly greater weight loss.

CONCLUSIONS AND IMPLICATIONS: Results suggest that declines in perceived barriers to healthful eating during treatment are associated with greater energy restriction and weight loss.

%B J Nutr Educ Behav %V 44 %P 507-12 %8 2012 Nov-Dec %G eng %N 6 %R 10.1016/j.jneb.2010.06.005 %0 Journal Article %J Obesity (Silver Spring) %D 2011 %T Sex-specific HDL cholesterol changes with weight loss and their association with anthropometric variables: the LIFE study. %A Yatsuya, Hiroshi %A Jeffery, Robert W %A Erickson, Darin J %A Welsh, Ericka M %A Flood, Andrew P %A Jaeb, Melanie A %A Laqua, Patricia S %A Mitchell, Nathan R %A Langer, Shelby L %A Levy, Rona L %K Anthropometry %K Blood Glucose %K Cholesterol, HDL %K Female %K Humans %K Insulin %K Male %K Middle Aged %K Obesity %K Sex Factors %K Subcutaneous Fat %K Triglycerides %K Waist-Hip Ratio %K Weight Loss %X

Decrease in the level of high-density lipoprotein cholesterol (HDLC) has been observed in women who start dieting, but not in men. Patterns of HDLC change during intentional weight loss through 30-months of follow-up, and their association with changes in anthropometric measurements were examined in obese women (N = 112) and men (N = 100). Missing HDLC values at 6-, 12-, 18-, and 30-month follow-up (N = 16, 34, 55, and 50, respectively) due to dropout were imputed by multiple imputation. Mean ages and BMIs of subjects at baseline were 47.2 years and 34.8 kg/m(2) for women, and 50.4 years and 35.0 kg/m(2) for men. On average, participants lost weight steadily for 12 months, followed by slow regain. During the first 6 months, HDLC decreased significantly in women (-4.1 mg/dl, P = 0.0007), but not in men. Significant HDLC increases were observed in both men and women from 6- to 12-month follow-up. HDLC changes in women were positively associated with changes in hip circumference from baseline to 12-month independent of changes in triglycerides (TG), glucose, and insulin. Rapid decrease of predominantly subcutaneous fat in the femoral and gluteal area might be associated with HDLC decrease in women during initial weight loss.

%B Obesity (Silver Spring) %V 19 %P 429-35 %8 2011 Feb %G eng %N 2 %R 10.1038/oby.2010.216 %0 Journal Article %J Am J Gastroenterol %D 2010 %T Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. %A Levy, Rona L %A Langer, Shelby L %A Walker, Lynn S %A Romano, Joan M %A Christie, Dennis L %A Youssef, Nader %A DuPen, Melissa M %A Feld, Andrew D %A Ballard, Sheri A %A Welsh, Ericka M %A Jeffery, Robert W %A Young, Melissa %A Coffey, Melissa J %A Whitehead, William E %K Abdominal Pain %K Adaptation, Psychological %K Adolescent %K Child %K Cognitive Therapy %K Disability Evaluation %K Female %K Humans %K Linear Models %K Male %K Pain Measurement %K Parent-Child Relations %K Parents %K Prospective Studies %K Treatment Outcome %X

OBJECTIVES: Unexplained abdominal pain in children has been shown to be related to parental responses to symptoms. This randomized controlled trial tested the efficacy of an intervention designed to improve outcomes in idiopathic childhood abdominal pain by altering parental responses to pain and children's ways of coping and thinking about their symptoms.

METHODS: Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions-a three-session intervention of cognitive-behavioral treatment targeting parents' responses to their children's pain complaints and children's coping responses, or a three-session educational intervention that controlled for time and attention. Parents and children were assessed at pretreatment, and 1 week, 3 months, and 6 months post-treatment. Outcome measures were child and parent reports of child pain levels, function, and adjustment. Process measures included parental protective responses to children's symptom reports and child coping methods.

RESULTS: Children in the cognitive-behavioral condition showed greater baseline to follow-up decreases in pain and gastrointestinal symptom severity (as reported by parents) than children in the comparison condition (time x treatment interaction, P<0.01). Also, parents in the cognitive-behavioral condition reported greater decreases in solicitous responses to their child's symptoms compared with parents in the comparison condition (time x treatment interaction, P<0.0001).

CONCLUSIONS: An intervention aimed at reducing protective parental responses and increasing child coping skills is effective in reducing children's pain and symptom levels compared with an educational control condition.

%B Am J Gastroenterol %V 105 %P 946-56 %8 2010 Apr %G eng %N 4 %R 10.1038/ajg.2010.106 %0 Journal Article %J Prev Med %D 2010 %T Maintenance-tailored therapy vs. standard behavior therapy for 30-month maintenance of weight loss. %A Levy, Rona L %A Jeffery, Robert W %A Langer, Shelby L %A Graham, Dan J %A Welsh, Ericka M %A Flood, Andrew P %A Jaeb, Melanie A %A Laqua, Patricia S %A Finch, Emily A %A Hotop, Annie M %A Yatsuya, Hiroshi %K Adult %K Behavior Therapy %K Humans %K Male %K Middle Aged %K Obesity %K Weight Gain %K Weight Loss %X

OBJECTIVE: To assess differences in weight regain one year after an 18-month obesity treatment with standard behavior therapy (SBT) or maintenance-tailored therapy for obesity (MTT).

METHOD: 213 obese adult volunteers were treated for 18 months using SBT with fixed behavioral prescriptions or MTT that employed varied behavioral prescriptions with treatment breaks. Follow-up analysis focused on weight maintenance after a year of no contact. The trial was conducted at the University of Minnesota between 2005 and 2009.

RESULTS: Mean (SD) weight change between 18 and 30 months for participants in the SBT group was +4.1 kg (4.4) compared to +2.8 kg (4.5) in the MTT group. This is a 31% reduction in weight regain in MTT relative to SBT (p=0.078). This trend toward better maintenance in MTT versus SBT was due primarily to superior differential maintenance in MTT participants in the highest tertile of total weight loss at 18 months, i.e. MTT participants in this tertile regained 4 kg less than SBT participants between 18 and 30 months.

CONCLUSIONS: The MTT approach with varied content and timing produced more desirable patterns of weight loss maintenance than the traditional SBT approach, especially among individuals who had achieved greater initial weight loss.

%B Prev Med %V 51 %P 457-9 %8 2010 Dec %G eng %N 6 %R 10.1016/j.ypmed.2010.09.010 %0 Journal Article %J Behav Res Ther %D 2010 %T Overgeneralization from limited data: A commentary on Cooper et al., 2010. %A Jeffery, Robert W %A Levy, Rona L %K Behavior Therapy %K Behavioral Research %K Humans %K Obesity %K Randomized Controlled Trials as Topic %X

This article comments on a recent paper by Cooper et al. in BRAT. Its main purpose is to comment on the provocative conclusion in the paper that behavioral research on weight loss maintenance should be abandoned. We disagree, arguing that the authors over generalize from their research, under crediting past behavioral weight loss research for its accomplishments, which are considerable. We briefly outline areas we believe remain exciting new research directions in this field.

%B Behav Res Ther %V 48 %P 714-6 %8 2010 Aug %G eng %N 8 %R 10.1016/j.brat.2010.05.016