Factors associated with achieving a weight loss goal among participants in an adapted Diabetes Prevention Program

doi:10.1016/j.pcd.2010.12.001

Primary Care Diabetes

Volume 5, Issue 2, July 2011, Pages 125-129

https://doi.org/10.1016/j.pcd.2010.12.001 Get rights and content

Abstract

Aims

To assess the factors associated with achieving the 7% weight loss goal among participants enrolled in an adapted Diabetes Prevention Program (DPP).

Methods

Adults at high-risk (N = 989) for CVD and diabetes were enrolled in the lifestyle intervention. Multiple logistic regression analyses were used to identify factors associated with achieving the weight loss goal.

Results

Overall 37% of participants achieved the weight loss goal. Participants who were older, male, had a lower baseline BMI, self-monitored their fat and caloric intake more frequently, and who achieved higher levels of physical activity were more likely to achieve the weight loss goal compared to participants without these characteristics. In multivariate analyses more frequent self-monitoring of fat and caloric intake and higher levels of weekly physical activity were the only factors independently associated with participant achievement of the weight loss goal.

Conclusions

In a real-world translation of the DPP lifestyle intervention participants who achieved the weight loss goal were more likely to have monitored their dietary intake frequently and increased their physical activity markedly both in a dose–response relationship. Our findings highlight the importance of supporting participants in lifestyle interventions to initiate and maintain dietary self-monitoring and increased levels of physical activity.

Introduction

The Finnish and the United States Diabetes Prevention Programs (DPP) both demonstrated that the incidence of type 2 diabetes mellitus among adults at high-risk for diabetes can be significantly reduced through an intensive lifestyle intervention [1], [2]. In the U.S. the incidence of type 2 diabetes among participants in the lifestyle group of the U.S. DPP was reduced by 58% compared to the placebo group at the completion of the study and by 34% a decade after enrollment [2], [3]. Forty-nine percent of the participants in the lifestyle arm of the trial achieved the 7% weight loss goal during the intervention and two factors, success at achieving the physical activity goal, and the number of weeks participants self-monitor their fat intake, were independently associated with meeting the weight loss goal [4].

Since the publication of the DPP, multiple translation studies have been conducted in the United States showing that it is feasible to recruit and retain adults at high risk for cardiovascular disease (CVD) and type 2 diabetes into adapted DPP lifestyle intervention programs, and to achieve weight loss and physical activity goals comparable to that achieved by the DPP participants [5], [6], [7], [8], [9], [10], [11]. The majority of these translation studies enrolled small cohorts of high-risk participants and none of the published translation studies have yet evaluated the factors that are associated with participants achieving the 7% weight loss goal in a real-world setting.

Beginning in 2008, the Montana Department of Public Health and Human Services (DPHHS) implemented an adapted group-based CVD and Diabetes Prevention Program [5], [12]. The findings suggest that participants can achieve weight loss and physical activity goals, and significant improvement in their cardiometabolic risk profile [12]. This report describes the factors associated with achieving the 7% weight loss goal among a larger cohort of participants enrolled in our prevention program.

Section snippets

Methods

A description of this intervention has been published previously [5]. Briefly, the Montana DPHHS funded 8 diabetes self-management education (DSME) programs beginning in 2008 to implement an adapted DPP. Sites used trained health professionals as lifestyle coaches to provide the 16-session core followed by 6 monthly after core sessions (intervention length of 10 months).

Characteristics of participants

Nine hundred and eighty-nine participants enrolled in the program and 816 (83%) completed the core intervention. Three-quarters of all participants enrolled in the program were 45 years of age and older (Table 1). The majority of participants were female, had a baseline BMI >35.0 kg/m², and attended 13 or more intervention sessions. Forty-six percent of participants self-monitored their fat intake for seven to thirteen weeks, 31% self-monitored their caloric intake for nine weeks, and 24%

Summary of main findings and comparisons with other studies

Our findings suggest that the frequency of fat and caloric self-monitoring and higher levels of weekly physical activity among participants are independently associated with achievement of the 7% weight loss goal among participants in this translation study. In the U.S. DPP 49% of participants in the lifestyle arm achieved the 7% weight loss goal, which is somewhat higher than what was achieved by participants in our translation study (37%) [4]. Similar to our findings, the DPP investigators

Conflict of interest

The authors state that they have no conflict of interest.

Acknowledgements

This project was funded through the Montana State Legislature and supported through a cooperative agreement with the Centers for Disease Control and Prevention (CDC), Division of Diabetes Translation (U32/CCU822743-05) in Atlanta, Georgia. The contents of this report are solely the responsibility of the authors and do not necessarily represent the views of the CDC.

References (18)

R.T. Ackermann et al.
Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study
Am. J. Prev. Med.
(2008)
M.K. Kramer et al.
Translating the Diabetes Prevention Program: a comprehensive model for prevention training and program delivery
Am. J. Prev. Med.
(2009)
A.J. Garber et al.
Diagnosis and management of prediabetes in the continuum of hyperglycemia: when do the risks of diabetes begin? A consensus statement from the American College of Endocrinology and the American Association of Clinical Endocrinologists
Endocr. Pract.
(2008)
J. Tuomilehto et al.
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance
N. Engl. J. Med.
(2001)
W.C. Knowler et al.
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
N. Engl. J. Med.
(2002)
W.C. Knowler et al.
10-Year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study
Lancet
(2009)
R.R. Wing et al.
Achieving weight and activity goals among Diabetes Prevention Program lifestyle participants
Obes. Res.
(2004)
H.A. Amundson et al.
Translating the Diabetes Prevention Program into practice in the general community
Diabetes Educ.
(2009)
S.L. Pagoto et al.
Translating the Diabetes Prevention Program into a hospital-based weight loss program
Health Psychol.
(2008)

There are more references available in the full text version of this article.

Cited by (32)

Defining Adherence to Dietary Self-Monitoring Using a Mobile App: A Narrative Review
2018, Journal of the Academy of Nutrition and Dietetics
Citation Excerpt :
Counting the recording of any dietary intake for a given day or week as adherent to dietary self-monitoring may drastically lower the amount of dietary intake recording required for adherence. This definition may be problematic because increased frequency of dietary self-monitoring22,63 as well as the combination of high frequency and high consistency of self-monitoring21 have been associated with weight loss. Defining adherence purely in terms of the number of logins to an app presents more challenges because it may be unknown what actions the app user chose after logging in, and/or what app content was accessed.
Understanding how adherence to dietary self-monitoring with apps has been defined is a first step toward examining the relationship between adherence and weight loss. The purpose of this review was to explore how adherence to dietary self-monitoring has been defined in the empirical literature that addresses weight loss app use by overweight and obese adults. The integrative review method and the preferred reporting items for systematic reviews and meta-analyses guided this review. Scientific databases (n=5) were searched, which yielded 29 studies. Studies were screened, evaluated for data quality, and then analyzed according to the constant comparison method. Most studies were weak to moderate quality. Results indicated that adherence was operationally defined in two ways. Adherence was defined as either adherent or nonadherent based on the completion of recording a minimum amount of calorie intake or a calorie amount within a specific range of calories. Another way that adherence was defined was the frequency of dietary self-monitoring, which included the frequency of dietary intake recording, interaction with apps, and the timing of recording. Some studies defined adherence in both ways. Most included studies lacked diversity in study samples. Until a consensus is reached, it may be prudent to study multiple indicators of adherence to dietary self-monitoring using apps, and their respective relationships with weight loss. Studies are needed that address the type and degree of adherence to dietary self-monitoring with an app that is associated with weight loss in diverse populations.
Weight loss in the prevention and treatment of diabetes
2017, Preventive Medicine
The American Diabetes Association nutrition and lifestyle recommendations for prediabetes and type 2 diabetes focus on losing 7% of body weight and increasing physical activity to at least 150 min per week. This emphasis is largely based on results of the Diabetes Prevention Program (DPP) and Look AHEAD (Action for Health in Diabetes) clinical trials. DPP demonstrated that a lifestyle intervention aimed at 7% weight loss and 150 min of activity per week reduced diabetes incidence by 58% after 2.8 years of follow-up and resulted in sustained improvements in hemoglobinA1c, blood pressure and lipid levels. After 15 years of follow-up, DPP's lifestyle intervention sustained a 27% risk reduction in progression to diabetes. Look AHEAD's lifestyle intervention significantly reduced hemoglobinA1c, blood pressure, triglycerides, and the amount and costs of medications needed to treat these conditions when compared with diabetes support and education. Other clinical and psychological benefits achieved with lifestyle intervention were greater reductions in c-reactive protein, less self-reported retinopathy, reduced risk of nephropathy, less sexual dysfunction, decreased incidence of urinary incontinence and fatty liver, remission of sleep apnea, better physical functioning, less knee pain, more remission of diabetes, reduced incidence of depression, less body image dissatisfaction and improved quality-of-life. A number of DPP translation studies have demonstrated weight losses of 4 to 7% at 6 month and 1 year follow-up which has led to Medicare coverage for CDC recognized DPP lifestyle programs starting in April 2018. Translation studies of Look AHEAD using a variety of delivery formats are underway.
Dietary Self-Monitoring in Weight Management: Current Evidence on Efficacy and Adherence
2015, Journal of the Academy of Nutrition and Dietetics
Citation Excerpt :
Burke and colleagues4 conducted a systematic review of articles published between 1993 and 2009 and found consistent, notable associations between self-monitoring and weight loss. More recent studies provide further evidence regarding the effect of different types of dietary self-monitoring on weight loss among different populations.8,27-31 Dietary self-monitoring can be categorized into three types: paper record (pen and paper records), web-based self-monitoring, and mobile devices (personal digital assistants, wearables, and mobile telephones).
Early Weight-Loss Success Identifies Nonresponders after a Lifestyle Intervention in a Worksite Diabetes Prevention Trial
2015, Journal of the Academy of Nutrition and Dietetics
People with prediabetes are at increased risk for developing type 2 diabetes mellitus. Weight reduction through lifestyle modification can significantly reduce diabetes risk. Yet, weight loss varies among individuals and some people do not achieve clinically meaningful weight loss after treatment.
Our aim was to evaluate the time point and threshold for achieving ≥5% weight loss after completion of a 16-week worksite, lifestyle intervention for diabetes prevention.
Weight change before and after the behavioral intervention among participants randomized to the experimental group was examined.
Individuals with prediabetes aged 18 to 65 years with a body mass index (calculated as kg/m²) of 25 to 50 at Ohio State University were eligible.
The 16-week, group-based intervention, adapted from the Diabetes Prevention Program, was delivered to 32 participants in the experimental group.
Percent weight loss was assessed weekly during the intervention and at 4- and 7-month follow-up.
Linear regression modeled the relationship between percent weight loss during month 1 of the intervention and percent weight loss at 4 and 7 months. Logistic regression modeled failure to lose ≥5% weight loss at 4 and 7 months using weekly weight change during the first month of intervention.
Percent weight loss at intervention week 5 was significantly associated with percent weight loss at 4 and 7 months (all P<0.001). Only 11.1% and 12.5% of participants who failed to achieve a 2.5% weight-loss threshold during month 1 achieved ≥5% weight loss at months 4 and 7, respectively.
The first month of lifestyle treatment is a critical period for helping participants achieve weight loss. Otherwise, individuals who fail to achieve at least 2.5% weight loss may benefit from more intensive rescue efforts or stepped-care interventions.
Evaluation of physical activity reporting in community Diabetes Prevention Program lifestyle intervention efforts: A systematic review
2015, Preventive Medicine
Citation Excerpt :
Other methods of reporting included aerobic fitness, days per week of moderate and/or vigorous PA, MET-hours per week, self-efficacy, kilocalories energy expenditure per week, PA level, proportion of participants reporting regular activity (>=3 days per week), and/or proportion reporting any PA. In addition to primary PA outcomes, five studies report on the significant positive relationship between achieving PA goals and/or high PA level and achievement of weight loss goals (Amundson et al., 2009; Harwell et al., 2011; Pinelli et al., 2011; Vanderwood et al., 2011; Whittemore et al., 2009). Four studies included the proportion of participants submitting PA diaries/logs during intervention, but did not report any information on PA level or frequency (Cox et al., 2012; McTigue et al., 2009b; West et al., 2011; Trief et al., 2014).
The Diabetes Prevention Program (DPP) lifestyle intervention has been translated to community settings using the DPP goals of 7% weight loss and 150 min of moderate physical activity (PA) per week. Given that PA is a primary lifestyle goal and has been linked to improvements in metabolic health in the DPP, it is important to understand the role that PA plays in translation effort success. The purpose of this review is to thoroughly evaluate the reporting of PA methodology and results in DPP-based translations in order to guide future prevention efforts.
PubMed and Ovid databases were searched to identify peer-reviewed original research articles on DPP-based translations for adults at-risk for developing diabetes or cardiovascular disease, limited to English language publications from January 2002–March 2015.
72 original research articles describing 57 translation studies met eligibility criteria. All 57 study interventions included a PA goal, 47 studies (82%) collected participant PA information, and 34 (60%) provided PA results.
Despite PA being a primary intervention goal, PA methodology and results are under-reported in published DPP translation studies. This absence and inconsistency in reporting PA needs addressed in order to fully understand translation efforts' impact on participant health.
Intensive lifestyle intervention goals can be achieved as effectively with large groups as with small groups
2014, Primary Care Diabetes
Citation Excerpt :
The only variables associated with achievement of these weight loss goals were more frequent weekly self-monitoring of fat intake and achievement of the physical activity goal. These independent associations are consistent with findings from both the original NIH DPP and our previous work, which indicate more frequent self-monitoring of fat intake and achievement of the physical activity goal are the most important factors associated with the achievement of the 7% weight loss goal [15,16]. There are a number of limitations to our study.
The purpose of this study was to assess if group size is associated with weight loss outcomes among participants in an adapted diabetes prevention program.
Adults at high-risk (N = 841) for CVD and diabetes were enrolled in the lifestyle intervention in 2011. Multiple logistic regression analyses were used to identify if group size (smaller group < 16 participants; larger group ≥16 participants) was independently associated with weight loss outcomes among participants.
In the bivariate analyses, participants in the smaller groups compared to those in the larger groups were significantly more likely to have a higher baseline body mass index, to attend fewer intervention sessions, and less likely to self-monitor their fat intake for ≥14 weeks, and to have lost less weight during the core intervention (5.1 kg [SD 4.7] versus 5.8 kg [4.5]). However, analysis adjusting for age, sex, baseline BMI, achievement of the physical activity goal, number of weeks self-monitoring fat intake, and group size, found only two factors to be independently associated with achievement of the 7% weight loss goal: frequency of self-monitoring of fat intake and achievement of the physical activity goal.
Our findings indicate that intensive lifestyle intervention goals can be achieved as effectively with large or small groups.

View all citing articles on Scopus

¹: Members of the Montana Cardiovascular Disease and Diabetes Prevention Workgroup are identified in Appendix A.

View full text

Original researchFactors associated with achieving a weight loss goal among participants in an adapted Diabetes Prevention Program

Abstract

Aims

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Characteristics of participants

Summary of main findings and comparisons with other studies

Conflict of interest

Acknowledgements

Am. J. Prev. Med.

Am. J. Prev. Med.

Endocr. Pract.

Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance

N. Engl. J. Med.

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin

N. Engl. J. Med.

10-Year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study

Lancet

Achieving weight and activity goals among Diabetes Prevention Program lifestyle participants

Obes. Res.

Translating the Diabetes Prevention Program into practice in the general community

Diabetes Educ.

Translating the Diabetes Prevention Program into a hospital-based weight loss program

Health Psychol.

Original research
Factors associated with achieving a weight loss goal among participants in an adapted Diabetes Prevention Program