A comparison of two weight management programs for adults with mobility impairments

doi:10.1016/j.dhjo.2014.08.002

Disability and Health Journal

Volume 8, Issue 1, January 2015, Pages 61-69

We presented parts of the content of this manuscript at a poster presentation for the American Public Health Association.

https://doi.org/10.1016/j.dhjo.2014.08.002 Get rights and content

Abstract

Background

Individuals with physical disabilities experience disparities in obesity; yet few interventions have incorporated accommodations necessary for weight loss in this population.

Objective/Hypothesis

This project compared the effectiveness of two weight loss interventions among individuals with physical disabilities.

Methods

Adults with physical disabilities who were overweight or obese were randomized across two diet approaches: a modified version of the MyPlate diet (usual care (UC)) and a modified Stoplight Diet (SLDm) supplemented with portion-controlled meals. Project staff met monthly with each participant to measure weight, 24-recalls of diet intake, self-tracking of foods and beverages, and physical activity during the preceding month.

Results

Of 126 enrollees, 70% completed the initial 6-month diet phase and 60% of these completed a 6-month follow-up phase. Participants in the SLDm group reduced weight and BMI during the 6 month intervention, and maintained or lost more weight during the 6 month maintenance period. Alternately, the UC diet resulted in a reduction in weight and BMI only at 6 months. BMI from baseline was significantly more improved for SLDm than UC and, among those who lost weight, the SLDm group lost more weight at 6 and 12 months.

Conclusions

These results demonstrate that interventions with proper design and accommodations can overcome the barriers to weight loss unique to individuals with mobility impairments with low income. Additionally, the results suggest that using portion control may be more effective than teaching portion sizes.

Section snippets

Participants

Low-income adults with mobility difficulties were enrolled in the weight management study and randomly assigned to one of the two diet groups, using a 1:1 computer-generated randomization table. Project staff (a registered dietitian and an exercise physiologist) recruited participants by hanging flyers and talking with health care and other providers in hospitals, clinics, doctor's offices, and agencies serving individuals with physical disabilities. Participants were eligible if they (a) had a

Participants

At baseline, the SLDm diet group had a median age of 51.7 (mean 51.4) years and a median BMI of 43.3 (mean 43.8); the UC diet group had a median age of 52.8 (mean 52.3) years and a median BMI of 45.6 (mean 45.6) (Table 1). The majority of participants in both groups were white, non-Hispanic, and female. Ninety-one percent reported difficulty in walking, 95% reported difficulty in climbing stairs and/or standing, 86% had difficulty in completing simple daily routines. Seventy-one percent

Discussion

The results of this study suggest that the Meal Replacement diet can induce weight loss among individuals with mobility impairments, as it did for individuals with IDD.²⁵ Overall, the SLDm diet group lost more weight than the UC diet group during the intervention phase (median of 13.0 vs. 7.0 pounds) and was able to maintain the loss, or lose more, during the 12-month follow up. In addition, among those who lost weight, the SLDm diet group lost significantly more than the UC diet group, at both

Conclusion

People with mobility impairments face disparities in obesity compared to the general population. Moreover, they frequently encounter many obstacles for losing weight or maintaining a healthy weight. This study demonstrated that a program of diet and exercise education and monthly counseling with trained professionals can help overweight/obese people with mobility impairments lose weight. In addition, this intervention highlights the need to continue this line of research, especially to

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Cited by (19)

Group Lifestyle Balance Adapted for Individuals With Impaired Mobility: Outcomes for 6-Month RCT and Combined Groups at 12 Months
2020, American Journal of Preventive Medicine
Citation Excerpt :
Several studies report yielding modest but significant weight loss among people with mobility impairment that averaged 5.29 kg (weighted mean, range=2.1–10.2 kg) across 12 weeks to 12 months.16–22 Behavioral theory informed the intervention approach in 2 studies18,21 but only 1 included most of the ILI components.23 In their 12-month program, Reichard and colleagues23 provided participants 6 months of portion-controlled meals to support calorie reduction plus incorporated several ILI components: self-monitoring, exercise, and monthly in-person sessions.
This study examines the feasibility and effectiveness of an intensive lifestyle intervention adapted for people with impaired mobility.
This was a randomized, wait-list controlled trial. The experimental group immediately received the 12-month weight loss program; the wait-list control group received it after a 6-month delay. Between-group comparisons were conducted for the 6-month RCT study design. Repeated measures were conducted for both groups combined after receiving the 12-month intervention. Data were collected August 2015–February 2017 and analyzed in 2017.
A community-based sample received 23, group-based sessions via a mix of telephone and in-person sessions in a hospital-based setting. Participants with impaired mobility (n=66) were middle-aged (49.80 [SD=11.37] years), mostly White (66.7%), female (66.7%), and most commonly had spinal cord injury (47.0%).
The 12-month intervention delivered 23 group-based sessions that promoted weight loss through reducing caloric intake and increasing physical activity.
Primary outcomes were effectiveness measured as change in weight and time spent in moderate physical activity. Feasibility was assessed in 12-month combined group analyses, measured as retention, attendance, and dietary self-monitoring.
The 6-month RCT results showed that the immediate and delayed groups differed significantly (p<0.05) in weight (−1.66 [SD=4.42] kg loss vs 0.05 [SD=4.15] kg gain) and moderate physical activity (52.93 [SD=90.74] minutes/week increase vs −14.22 [SD=96.02] minutes/week decrease), accounting for baseline weight, time with disability, and age of onset. The 12-month results with groups combined demonstrated 74.2% retention and 77.7% core session attendance. Self-monitoring was higher in the delayed group (77.3%), who used a smartphone app, than the immediate group (47.3%), who mostly used paper trackers. Participants achieved significant 12-month weight loss of 3.31 (SD=10.13) kg (d=0.33) in mixed modeling analyses with groups combined yet did not significantly increase moderate physical activity.
Group Lifestyle Balance Adapted for Individuals with Impaired Mobility is a feasible, effective approach to teach healthy lifestyle skills to individuals with mobility impairment, yielding modest weight loss and enhanced self-efficacy.
This study is registered at www.clinicaltrials.gov NCT03307187.
Weight management for adults with mobility related disabilities: Rationale and design for an 18-month randomized trial
2020, Contemporary Clinical Trials
Citation Excerpt :
3) Our previous trial in adults with MRDs demonstrated ~6% weight loss at 12 mos. using the eSLD, which was significantly greater than achieved with a meal plan diet (−0.6%) [23]. Additionally, the Veterans Administrations (VA) “Aspire” weight loss intervention [101,102] has also demonstrated significantly greater weight loss at 12 mos.
Adults with mobility related disabilities (MRDs) represent an underserved group with a high prevalence of overweight/obesity and limited options for weight management. We previously demonstrated clinically meaningful 12-month weight loss in adults with MRDs (−6.2%, 36% ≥5% of baseline weight) using an enhanced Stop Light Diet (eSLD) delivered using at home face-to-face behavioral sessions and optional physical activity. However, the costs/logistics associated with intervention delivery by individual home visits limits the potential for scaling and implementation of this approach. Thus, we will conduct a two-arm randomized trial in 128 overweight/obese adults with MRDs to compare weight loss (6 mos.) and maintenance (12 mos.) between interventions utilizing the eSLD, behavioral counseling, and increased physical activity delivered to individual participants in their homes or delivered to groups of participants in their homes remotely via video conferencing. The primary aim will compare weight loss between interventions arms across 6 months. Secondarily, we will compare weight loss (0–18 mos.), the proportion of participants who achieve clinically meaningful weight loss (≥5%) from 0 to 6 and 0 to18 months, and changes in quality of life from 0 to 6 and 0 to 18 months between interventions arms. We will also conduct cost, cost-effectiveness and contingent valuation comparisons and explore the influence of behavioral session attendance, compliance with the recommendations for diet and physical activity, self-monitoring of diet and physical activity, barriers to physical activity, sleep quality, and medications on weight change across 6 and 18 months.
NCT04046471
Pilot randomized trial of a telephone-delivered physical activity and weight management intervention for individuals with lower extremity amputation
2019, Disability and Health Journal
Obesity and inactivity are common and burdensome for people with lower extremity amputation (LEA). The extent to which home-based physical activity/weight management programs are effective and safe for people with LEA is unknown. Translating effective interventions for understudied disability groups is needed.
To test the feasibility, acceptability, and safety of a weight management and physical activity intervention and obtain preliminary efficacy estimates for changes in weight, body composition, and physical functioning.
Eligibility criteria included: LEA ≥1 year prior, 18–69 years of age, overweight or obese and living in the Seattle area. The intervention arm received self-monitoring tools (e.g., pedometer, scale) and written materials, a single exercise counseling home visit by a physical therapist, and up to 11 telephone calls from a health coach over 20 weeks that involved motivational interviewing to set specific, attainable, and measurable goals. The self-directed control group received the same tools and materials but no home visit or coaching calls.
Nineteen individuals consented to participate, 15 were randomized (mean age = 56, 73% male, 80% transtibial amputation) and 11 completed 20-week follow-up assessments. The intervention was acceptable and safe. Coached participants had greater decreases in waist circumference (mean difference between groups over 20 weeks, baseline values carried forward: −4.3 cm, 95% CI -8.2, −0.4, p = 0.03) and fat mass (−2.1 kg, 95% CI -3.8, −0.4, p = 0.02).
The home-based intervention was promising in terms of efficacy, safety and acceptability. Inclusion of multiple trial centers and increased use of technology may facilitate recruitment and retention.
Remote delivery of weight management for adults with intellectual and developmental disabilities: Rationale and design for a 24 month randomized trial
2018, Contemporary Clinical Trials
Adults with intellectual and developmental disabilities (IDD) represent an underserved segment of the US population with a high prevalence of obesity and limited options for weight management. Previous research has demonstrated clinically meaningful weight loss of 7% of total body weight in in adults with IDD using an enhanced Stop Light Diet (eSLD) in combination with monthly at-home face-to-face (FTF) behavioral sessions, and a recommendation for increased physical activity. However, the time and cost associated with FTF delivery (travel + sessions) limits the potential for scaling and implementation and suggests the need for the evaluation of less costly and burdensome strategies for intervention delivery. Therefore, we will conduct a 24-mo. randomized trial to compare a weight management intervention (6 mos. weight loss, 12 mos. maintenance, 6 mos. no-contact follow-up) delivered to 120 overweight/obese adults with IDD in their home, either remotely (RD) using video conferencing on a tablet computer, or during FTF visits. Our primary aim is whether RD is non-inferior to FTF for weight loss (0–6 mos.). Secondarily, we will compare the RD and FTF groups on mean weight loss, the proportion of participants who achieve clinically meaningful weight loss, and changes in quality of life across 24 months. We will also conduct cost analysis, cost-effectiveness, and contingent valuation analyses to compare the RD and FTF groups.
A scoping review on interventions to promote physical activity among adults with disabilities
2018, Disability and Health Journal
Despite the strong evidence that physical activity (PA) is a key determinant of health, there is limited knowledge on the content and outcomes of PA promotion interventions among individuals with disabilities.
To conduct a scoping review in order to examine the published literature on PA promotion interventions among adults with disabilities.
A scoping review following the methodological framework provided by Arksey and O'Malley used electronic databases (MEDLINE, PsycINFO, and CINAHL), reference lists, and journals to locate studies. Inclusion criteria were based on study aim, outcome measures, and a disability definition by the WHO International Classification of Functioning, Disability and Health. The Behavior Change Techniques Taxonomy version 1 and Furlan and collaborators' risk of bias assessment were utilized during the data charting stage.
Thirty-eight articles met the inclusion criteria. Most of the studies (70%) reported a significant increase in PA behavior immediately following intervention. However, less than half of the studies (46%) examined the maintenance of pre-/post-test differences. The number of identified behavior change techniques was significantly higher for successful PA promotion interventions than for interventions with no effects on PA. Approximately one-third of studies (32%) were rated as having a high risk of bias.
Although findings support the idea that PA promotion interventions produce positive changes in PA behavior for a variety of disability conditions, risk of bias assessment calls for prudence. There are opportunities for continued development of the area of PA promotion among individuals with disabilities through systematic reviews and meta-analyses.
Reducing barriers to healthy weight: Planned and responsive adaptations to a lifestyle intervention to serve people with impaired mobility
2018, Disability and Health Journal
People with impaired mobility (IM) disabilities have a higher prevalence of obesity and obesity-related chronic conditions; however, lifestyle interventions that address the unique needs of people with IM are lacking.
This paper describes an adapted evidence-based lifestyle intervention developed through community-based participatory research (CBPR).
Individuals with IM, health professionals, disability group representatives, and researchers formed an advisory board to guide the process of thoroughly adapting the Diabetes Prevention Program Group Lifestyle Balance (DPP GLB) intervention after a successful pilot in people with IM. The process involved two phases: 1) planned adaptations to DPP GLB content and delivery, and 2) responsive adaptations to address issues that emerged during intervention delivery.
Planned adaptations included combining in-person sessions with conference calls, providing arm-based activity trackers, and adding content on adaptive cooking, adaptive physical activity, injury prevention, unique health considerations, self-advocacy, and caregiver support. During the intervention, participants encountered numerous barriers, including health and mental health issues, transportation, caregivers, employment, adjusting to disability, and functional limitations. We addressed barriers with responsive adaptations, such as supporting electronic self-monitoring, offering make up sessions, and adding content and activities on goal setting, problem solving, planning, peer support, reflection, and motivation.
Given the lack of evidence on lifestyle change in people with disabilities, it is critical to involve the community in intervention planning and respond to real-time barriers as participants engage in change. A randomized controlled trial (RCT) is underway to examine the usability, feasibility, and preliminary effectiveness of the adapted intervention.

View all citing articles on Scopus

: We have no conflicts of interest to report.

: This work was funded under a Field Initiated Project from the National Institute on Disability and Rehabilitation Research, award number H133G090230.

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Published by Elsevier Inc.

Research PaperA comparison of two weight management programs for adults with mobility impairments

Abstract

Background

Objective/Hypothesis

Methods

Results

Conclusions

Section snippets

Participants

Participants

Discussion

Conclusion

Disabil Health J

J Nutr

Am J Clin Nutr

Disability and Functioning (Adults)

State-specific prevalence of obesity among adults with disabilities–eight states and the District of Columbia, 1998-1999

MMWR Morb Mortal Wkly Rep

Years of life lost due to obesity

J Am Med Assoc

Relation of parental history of coronary heart disease to obesity in young adults

Int J Obes Relat Metab Disord

Press releases: translating research into news

J Am Med Assoc

Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors

J Am Med Assoc

Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials

Hypertension

The effect of cardiorespiratory fitness and obesity on cancer mortality in women and men

Med Sci Sports Exerc

Intentional weight loss and incidence of obesity-related cancers: the Iowa Women's Health Study

Int J Obes Relat Metab Disord

Prevalence and trends in obesity among aged and disabled U.S. Medicare beneficiaries, 1997-2002

Health Aff (Millwood)

Physical disability and obesity

Nutr Rev

Research Paper
A comparison of two weight management programs for adults with mobility impairments