Assessment of Diet in Patients with Inflammatory Bowel Disease: A Collaboration of Behavioral and Basic Scientists

Introduction: Clinical research to develop treatment for inflammatory bowel disease (IBD) is focusing on a nutritional regimen restricting certain carbohydrates while incorporating the use of an optimal diet that includes pre- and probiotic foods. Current assessments are not able to measure elements of this nutritional regimen, thus we developed a food frequency questionnaire (FFQ). This FFQ will be utilized in a prospective study of IBD patients following an anti-inflammatory diet (IBD-AID) developed by us and used clinically at UMASS. We will track the bacterial communities inhabiting the microbiome of patients to determine diet-dependent changes, and their relation with patient wellbeing. Objectives: 1) Develop an FFQ capable of identifying dietary components important to IBD: prebiotics, probiotics, beneficial nutrient intake, and avoidance of certain foods. 2) Determine diet-dependent changes of the gut microbiome. Hypothesis: This study will show the microbiome of patients adopting the IBD-AID converge to one or more healthy \u27enterotype\u27 signatures, as compared to a non-IBD-AID control group. Experimental design: Patients record daily FFQ. Foods and food groups (270) are categorized and grouped according to criteria of interest. Each food has a referent by which the patient can compare their own consumption. A scoring system satisfying dietary guidelines and components of the IBD-AID will be utilized. Twice per week patients collect stool samples for microbiome analysis. Microbiome composition and ecological metrics are compared to identify components influenced by the IBD-AID, and to separate bacterial \u27enterotype\u27 signatures of patients before, during and after diet intervention. We are currently recruiting patients

Physician-Delivered Weight Management Counseling (PD-WMC)

Introduction: Individuals with excess weight have increased morbidity and mortality compared to those of normal weight, and there are differences in disease risk between overweight and obese men and women. However, limited information on how physicians counsel these groups and on patients’ experiences with weight management counseling (WMC) is available. The goals of this study are to describe specific WMC approaches provided to patients, reported benefit of these strategies, and study participants’ WMC preferences. Methods:103 participants, stratified by BMI (Overweight: 25.0 ≤ BMI ≤ 29.9; Obese: BMI ≥ 30.0) and gender, completed surveys. Survey questions focused on WMC approaches (e.g., discussions about diet, generation of specific weight loss goals) currently provided by physicians, reported benefit of these methods, and patients’ WMC preferences for future care. Frequency counts were used in analysis of all questions. Chi-square and Fisher’s exact test (p \u3c .05) were performed to assess significance between stratified groups. Results: Participants reported receiving a wide-range of WMC, from discussions about diet to surgery. Overweight participants and women reported less counseling compared to obese individuals and men, respectively. Compared to men, women reported fewer discussions in areas such as past weight loss attempts (p=0.014) and effects of weight on long-term health (p=0.008). In general, participants found scheduling follow-up appointments most beneficial (72.8%). There were no significant differences by BMI or gender. Overall, participants most preferred that physicians increase support in generating specific strategies to assist in weight loss (74.8%) and in helping them to develop specific weight loss goals (65.1%). By gender, men most preferred increased development of weight loss strategies (70.0%) by their physicians and desired more discussions about the effects of weight on long-term health (63.3%). Women most preferred increased development of specific weight loss strategies (79.2%) as well as increased generation of specific weight loss goals (67.9%) by their physicians. Both overweight and obese participants (68.6% and 80.7%, respectively) sought increased development of weight loss strategies. Conclusions: This appears to be the first cross-sectional study comparing patients’ WMC experiences and preferences, stratified by BMI and gender. Results demonstrate that regardless of BMI and gender, patients want more WMC, with preference for certain strategies. Differences were noted between stratified groups

The Association Between Psychiatric Disorders and Frequent Indoor Tanning

Limited research has explored psychiatric disorders associated with indoor tanning and tanning dependence. In a study conducted in 2006 of students at a large university in the northeastern United States, 90 of 229 (39%) who had used indoor tanning facilities met criteria for tanning dependence,a tanning pattern highly resistant to intervention. Given that tanners report mood and physical appearance as reasons for tanning, psychological disorders, such as seasonal affective disorder (SAD) and body dysmorphic disorder (BDD), may be common among this population. Past research found that 12 of 27 (44%) frequent indoor tanners met criteria for SAD compared with 14 of 56 (25%) nontanners. Other studies have found that stress in general is predictive of tanning dependence,and tanners have been shown to report lower levels of stress after tanning. Ashrafioun and Bonarreported that 57 of 165 (35%) tanners who met criteria for tanning dependence also met criteria for BDD, compared with 77 of 368 (21%) tanners who did not meet these criteria. In the study described here, we assessed the prevalence of SAD, clinically elevated stress, and BDD among a sample of women who frequently use indoor tanning, and we examined bivariate associations between tanning dependence and these psychological conditions

The Feasibility of Incentivizing Participation in an Online Social Network Weight Loss Program

Engagement in online social network-delivered weight loss interventions is a predictor of weight loss. Incentivizing engagement in a subset of participants may increase group engagement and subsequent weight loss. In a pilot feasibility trial, 56 adults with obesity were randomized to two Facebook-delivered weight loss interventions, one had 10% users incentivized to engage daily and the other did not. We compared conditions on engagement and weight loss, and then compared incentivized users and natural high engagers on weight loss. Participants were 46.3 (SD: 10.3) years and 89% female. The incentivized user condition had greater total engagement (p=0.0361), but weight loss did not differ (p=0.2096). Three natural superusers emerged in each condition. Natural superusers lost more weight than incentivized users (p=0.0358). Natural superusers’ posts elicited more comments than incentivized superusers (p=0.0107). Incentivized superusers may engage differently than natural superusers. Future studies should explore ways to promote engagement in online interventions

Obstructive Sleep Apnea and Weight Loss Treatment Outcome Among Adults With Metabolic Syndrome

OBJECTIVE: The purpose of this study was to examine whether adults with obesity and metabolic syndrome who screen as high risk for obstructive sleep apnea (OSA) lose less weight as part of a weight loss intervention than those who screen as low risk. METHOD: We conducted a secondary analysis of a randomized trial comparing 2 weight loss interventions consisting of dietary counseling for adults with obesity and metabolic syndrome. Participants were screened for sleep apnea using a validated screening questionnaire. Percent weight loss was calculated from weight measured at baseline and intervention end (12 months). Weight loss of 5% or greater was considered clinically significant. Multivariate linear and logistic regression models estimated the association between OSA screening status (high vs. low risk) and percent weight loss and clinically significant weight loss, adjusting for relevant covariates including body mass index and sleep duration. RESULTS: Nearly half of participants (45.8%) screened as high risk for OSA. Participants who screened as high risk for OSA lost less weight (1.2% +/- 4.2% vs. 4.2% +/- 5.3%) and were less likely to lose 5% or greater (24.4% vs. 75.6%) than participants without OSA. CONCLUSION: Among adults with obesity and metabolic syndrome, those at high risk for OSA lost less weight in response to a dietary counseling intervention than adults with low risk of OSA. Routine OSA screening should be considered as part of weight loss treatment programs. Additional research is needed to determine how to tailor weight loss treatment for those with high risk for OSA. (PsycINFO Database Recor

Twitter-Delivered Behavioral Weight-Loss Interventions: A Pilot Series

BACKGROUND: Lifestyle interventions are efficacious at reducing risk for diabetes and cardiovascular disease but have not had a significant public health impact given high cost and patient and provider burden. OBJECTIVE: Online social networks may reduce the burden of lifestyle interventions to the extent that they displace in-person visits and may enhance opportunities for social support for weight loss. METHODS: We conducted an iterative series of pilot studies to evaluate the feasibility and acceptability of using online social networks to deliver a lifestyle intervention. RESULTS: In Study 1 (n=10), obese participants with depression received lifestyle counseling via 12 weekly group visits and a private group formed using the online social network, Twitter. Mean weight loss was 2.3 pounds (SD 7.7; range -19.2 to 8.2) or 1.2% (SD 3.6) of baseline weight. A total of 67% (6/9) of participants completing exit interviews found the support of the Twitter group at least somewhat useful. In Study 2 (n=11), participants were not depressed and were required to be regular users of social media. Participants lost, on average, 5.6 pounds (SD 6.3; range -15 to 0) or 3.0% (SD 3.4) of baseline weight, and 100% (9/9) completing exit interviews found the support of the Twitter group at least somewhat useful. To explore the feasibility of eliminating in-person visits, in Study 3 (n=12), we delivered a 12-week lifestyle intervention almost entirely via Twitter by limiting the number of group visits to one, while using the same inclusion criteria as that used in Study 2. Participants lost, on average, 5.4 pounds (SD 6.4; range -14.2 to 3.9) or 3.0% (SD 3.1) of baseline weight, and 90% (9/10) completing exit interviews found the support of the Twitter group at least somewhat useful. Findings revealed that a private Twitter weight-loss group was both feasible and acceptable for many patients, particularly among regular users of social media. CONCLUSIONS: Future research should evaluate the efficacy and cost-effectiveness of online social network-delivered lifestyle interventions relative to traditional modalities

Weight loss support seeking on twitter: the impact of weight on follow back rates and interactions

People seek weight loss support on online social networks, but little is known about how to build a supportive community. We created four Twitter accounts portraying women interested in weight loss (two obese, two normal weight/overweight) and followed health care professional and peer accounts for 2-5 weeks. We examined follow back rates, interactions, and organic follows from professionals and peers by weight status. Follow back rates did not differ by weight status when following professionals (6.8 % normal weight/overweight vs 11.0 % for obese; p = 0.4167) or peers (6.7 % for normal weight/overweight vs 10.8 % for obese; p = 0.1548). Number of interactions and organic followers also did not differ by weight status. Peers interacted with study accounts significantly more than professionals (p = 0.0138), but interactions were infrequent. Women seeking weight loss support on Twitter may need to be present for more than 5 weeks to build an interactive weight loss community

Tobacco Use, Quitting Behavior, and Health Characteristics Among Current Electronic Cigarette Users in a National Tri-Ethnic Adult Stable Smoker Sample

INTRODUCTION: The present study characterizes the tobacco use, quitting behaviors, and health characteristics of cigarette smokers who did not change their smoking pattern over the past 6 months and have used electronic cigarettes (ECs) in the past 30 days. This is an important subpopulation to characterize if EC dual use with cigarettes continues to grow. METHODS: Participants (N = 2,376) from a research survey panel completed an online cross-sectional survey between June and August 2012. Sampling was stratified to recruit equal numbers of cigarette smoking participants by race/ethnicity (Black, Hispanic, and Caucasian) and smoking frequency (nondaily and daily). All displayed a stable rate of smoking for the past 6 months and were not currently in treatment. Bivariate and multivariate analyses were used to examine correlates of current EC use (any use within the past 30 days). RESULTS: Current EC use was reported by 9.2% (n = 219) of the total sample. Of current EC users, 44% reported having used ECs as a quit method. Bivariate and multivariate analyses showed that current EC use was significantly associated with greater nicotine dependence, concurrent poly-tobacco use, more past-year quit attempts, past use of multiple cessation methods, and more depressive symptoms. No demographic variables were significantly associated with current EC use. CONCLUSIONS: This study suggests that stable smokers who currently use ECs possess characteristics that are associated with difficulty in achieving smoking cessation. These characteristics should be considered when examining the effectiveness of ECs on cessation and in designing future cessation trials using ECs. Society for Research on Nicotine and Tobacco. All rights reserved

An online social network to increase walking in dog owners: a randomized trial

PURPOSE: Encouraging dog walking may increase physical activity in dog owners. This cluster-randomized controlled trial investigated whether a social networking Web site (Meetup) could be used to deliver a multicomponent dog walking intervention to increase physical activity. METHODS: Sedentary dog owners (n = 102) participated. Eight neighborhoods were randomly assigned to the Meetup condition (Meetup) or a condition where participants received monthly e-mails with content from the American Heart Association regarding increasing physical activity. The Meetup intervention was delivered over 6 months and consisted of newsletters, dog walks, community events, and an activity monitor. The primary outcome was steps; secondary outcomes included social support for walking, sense of community, perceived dog walking outcomes, barriers to dog walking, and feasibility of the intervention. RESULTS: Mixed-model analyses examined change from baseline to postintervention (6 months) and whether change in outcomes differed by condition. Daily steps increased over time (P = 0.04, d = 0.28), with no differences by condition. The time-condition interaction was significant for the perceived outcomes of dog walking (P = 0.04, d = 0.40), such that the Meetup condition reported an increase in the perceived positive outcomes of dog walking, whereas the American Heart Association condition did not. Social support, sense of community, and dog walking barriers did not significantly change. Meetup logins averaged 58.38 per week (SD, 11.62). Within 2 months of the intervention ending, organization of the Meetup groups transitioned from the study staff to Meetup members. CONCLUSIONS: Results suggest that a Meetup group is feasible for increasing physical activity in dog owners. Further research is needed to understand how to increase participation in the Meetup group and facilitate greater connection among dog owners