Original researchFactors associated with achieving a weight loss goal among participants in an adapted Diabetes Prevention Program
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.
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Cited by (32)
Defining Adherence to Dietary Self-Monitoring Using a Mobile App: A Narrative Review
2018, Journal of the Academy of Nutrition and DieteticsCitation 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.
Weight loss in the prevention and treatment of diabetes
2017, Preventive MedicineDietary Self-Monitoring in Weight Management: Current Evidence on Efficacy and Adherence
2015, Journal of the Academy of Nutrition and DieteticsCitation 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 DieteticsEvaluation of physical activity reporting in community Diabetes Prevention Program lifestyle intervention efforts: A systematic review
2015, Preventive MedicineCitation 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).
Intensive lifestyle intervention goals can be achieved as effectively with large groups as with small groups
2014, Primary Care DiabetesCitation 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.
- 1
Members of the Montana Cardiovascular Disease and Diabetes Prevention Workgroup are identified in Appendix A.