Deconstructing Weight Management Interventions for Young Adults: Looking Inside the Black Box of the EARLY Consortium Trials.

ObjectiveThe goal of the present study was to deconstruct the 17 treatment arms used in the Early Adult Reduction of weight through LifestYle (EARLY) weight management trials.MethodsIntervention materials were coded to reflect behavioral domains and behavior change techniques (BCTs) within those domains planned for each treatment arm. The analytical hierarchy process was employed to determine an emphasis profile of domains in each intervention.ResultsThe intervention arms used BCTs from all of the 16 domains, with an average of 29.3 BCTs per intervention arm. All 12 of the interventions included BCTs from the six domains of Goals and Planning, Feedback and Monitoring, Social Support, Shaping Knowledge, Natural Consequences, and Comparison of Outcomes; 11 of the 12 interventions shared 15 BCTs in common across those six domains.ConclusionsWeight management interventions are complex. The shared set of BCTs used in the EARLY trials may represent a core intervention that could be studied to determine the required emphases of BCTs and whether additional BCTs add to or detract from efficacy. Deconstructing interventions will aid in reproducibility and understanding of active ingredients

Weight change over five-year periods and number of components of the metabolic syndrome in a Dutch cohort

Overweight and obesity are associated with the metabolic syndrome (MetS). We studied the association of weight change over three consecutive 5-year periods with the number of MetS components in people aged 20–59 years. 5735 participants from the Doetinchem Cohort Study were included. Weight was measured in round 1 and at each 5-year interval follow-up (round 2, 3 and 4). Weight change was defined as the absolute weight change between two consecutive measurements. The number of MetS components (assessed in round 2, 3 and 4) was based on the presence of the following components of the MetS: central obesity, raised blood pressure, reduced high density lipoprotein cholesterol and elevated glucose. Associations of weight change and the number of components of the MetS were analyzed with Generalized Estimating Equations for Poisson regression, stratified for 10-year age groups. For each age group, 1 kg weight gain was positively associated with the number of components of the MetS, independent of sex and measurement round. The association was stronger in 30–39 years (adjusted rate ratio: 1.044; 95%CI: 1.040–1.049) and smaller in older age groups. Compared to stable weight (>−2.5 kg and < 2.5 kg), weight loss (≤−2.5 kg) and weight gain (≥2.5 kg) was associated with a lower and higher rate ratio respectively, for the number of components of the MetS. Our results support the independent association of weight change with the number of MetS components with a more pronounced association in younger people

Overweight, obesity and high blood pressure in an ethnically diverse sample of adolescents in Britain: the Medical Research Council DASH study

Objectives: To examine the impact of overweight on mean, high normal and high blood pressure in early adolescence, and how this relates to ethnicity and socio-economic status. Design: Cross-sectional study with anthropometric and blood pressure measurements. Setting: A total of 51 secondary schools in London. Sample: A total of 6407 subjects, 11–13 years of age, including 1204 White UK, 698 Other Whites, 911 Black Caribbeans, 1065 black Africans, 477 Indians and 611 Pakistanis/Bangladeshis. Main outcome measures: Mean, high normal (gender, age and height-percentile-specific 90–94th percentile) and high (greater than or equal to95th percentile) blood pressure. Results: Based on the International Obesity Task Force age-specific thresholds, 19% of boys and 23% of girls were overweight, and 8% of each were obese. Overweight and obesity were associated with large increases in the prevalence of high normal and high blood pressures compared with those not overweight. The increases in the prevalence of high systolic pressure associated with overweight were as follows: boys, odds ratio 2.50 (95% confidence intervals 1.73–3.60) and girls 3.39 (2.36–4.85). Corresponding figures for obesity were: boys 4.31 (2.82–6.61) and girls 5.68 (3.61–8.95). Compared with their White British peers, obesity was associated with larger effects on blood pressure measures only among Indians, despite more overweight and obesity among black Caribbean girls and overweight among Black African girls. The effect of socio-economic status was inconsistent. Conclusions: The tendency to high blood pressure among adult Black African origin populations was not evident at these ages. These results suggest that the rise in obesity in adolescence portends a rise in early onset of cardiovascular disease across ethnic groups, with Indians appearing to be more vulnerable