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

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)

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

Behavioral Weight Control

Antecedents Behavior Consequences

– Self-monitoring– Stimulus control– Problem solving– Social support– Goal setting– Cognitive restructuring– Relapse prevention

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…

The Bad News…

0

2

4

6

8

10

12

14

1M 3M 6M 1Y 5Y

Pe

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Treatment Follow-up

TIME IN WEEKS

Wadden et al., 1989

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

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

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

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

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%

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

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

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

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

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)