Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082

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Modifying Obesogenic Homes Impact on Weight
MaintenanceNHLBIHL077082

• 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

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Obesity Trends Among U.S. Adults2005
(BMI 30, or 30 lbs overweight for 5 4 woman)
No Data lt10 1014
1519 2024 2529
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Source Behavioral Risk Factor Surveillance
System, CDC.
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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

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Behavioral Weight Control

• Antecedents Behavior Consequences
• Self-monitoring
• Stimulus control
• Problem solving
• Social support
• Goal setting
• Cognitive restructuring
• Relapse prevention

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The Good News

• 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

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The Bad News
Wadden et al., 1989
Treatment
Follow-up
TIME IN WEEKS
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An Ecological Model of Obesity (NHLBI)
Developed for the NHLBI Workshop on Predictors of
Obesity, Weight Gain, Diet, and Physical
Activity August 4-5, 2004, Bethesda MD
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An Ecological Model of Obesity (NHLBI)
Developed for the NHLBI Workshop on Predictors of
Obesity, Weight Gain, Diet, and Physical
Activity August 4-5, 2004, Bethesda MD
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• 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

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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

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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

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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

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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

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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

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Assessing the Home Environment
Home visits at 0, 6, and 18 m

• Social home environment
• Type of support (autonomous vs. controlled) from
  partner
• Household support how supportive each person is
  of participants weight control efforts and
  whether or not they are interested in changing
  their own eating and exercise
• Sallis Support Measure

• 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

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Study Progress

• Recruitment
• 201 pairs (402 individuals) enrolled in the study
• 50.510.8 years
• 78.6 women
• 21.4 minority participation
• Retention
• 97 at 6 m
• 89 at 12 m
• 95 at 18 m (2 out of 6 waves completed)