Explore the vast range of titles available.

ObjectiveTo describe the relationship between metabolic health parameters and depressive symptoms and perceived stress, and whether the co-occurrence of these two psychological stressors has an additive influence on metabolic dysregulation in adults at different levels of body mass index (BMI) without diabetes.MethodsParticipants without diabetes (N = 20,312) from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study (recruited between 2003–2007) who had a body mass index (BMI) ≥ 18.5 kg/m2 were included in this cross-sectional analysis. Mean age of sample was 64.4 years, with 36% African American, and 56% women. Depressive symptoms and perceived stress were measured using brief versions of the Center for Epidemiologic Studies Depression (CES-D-4 item) questionnaire and Cohen Perceived Stress Scale (PSS), respectively. Metabolic health parameters included waist circumference, blood pressure (systolic and diastolic), low- and high-density lipoprotein (LDL, HDL) cholesterol, triglycerides, fasting glucose, and high sensitivity C-reactive protein (hs-CRP). Sequentially adjusted general linear regression models (GLM) for each metabolic parameter were used to assess the association between having both elevated depressive symptoms and stress, either of these psychological risk factors, or none with all analyses stratified by BMI category (i.e., normal, overweight, and obesity).ResultsThe presence of elevated depressive symptoms and/or perceived stress was generally associated with increased waist circumference, higher CRP, and lower HDL. The combination of depressive symptoms and perceived stress, compared to either alone, was typically associated with poorer metabolic health outcomes. However, sociodemographic and lifestyle factors generally attenuated the associations between psychological factors and metabolic parameters.ConclusionsElevated depressive symptoms in conjunction with high levels of perceived stress were more strongly associated with several parameters of metabolic health than only one of these psychological constructs in a large, diverse cohort of adults. Findings suggest that healthy lifestyle factors may attenuate the association between psychological distress and metabolic health impairment.

This commentary reviews common myths and presumptions about obesity and also provides some useful evidence-based concepts about overweight and obesity. Passionate interests, the human tendency to seek explanations for observed phenomena, and everyday experience appear to contribute to strong convictions about obesity, despite the absence of supporting data. When the public, mass media, government agencies, and even academic scientists espouse unsupported beliefs, the result may be ineffective policy, unhelpful or unsafe clinical and public health recommendations, and an unproductive allocation of resources. In this article, we review some common beliefs about obesity that are not supported by scientific evidence and also provide some useful evidence-based concepts. We define myths as beliefs held to be true despite substantial refuting evidence, presumptions . . .

Objectives/Goals: Nearly 42% of adults in the USA have obesity; women are disproportionately affected. Women with obesity that become pregnant are especially prone to developing health condition; thus, aid is needed to achieve appropriate gestational weight gain (GWG). GWG interventions would benefit from examining the effects of social support and stress has on GWG. Methods/Study Population: The proposed study will examine whether expecting mothers’ social support predicts their perceived stress. Also, examine whether receiving aid, in the form of weekly meal delivery, changes perceived stress. Lastly, this study will explore if social support mediates the relationship between meal delivery and perceived stress. The study will use data gathered from a pilot GWG intervention focused on providing pregnant women weekly meal delivery. Participants (N = 14) will complete 2 visits at 16–20- and 35–36-weeks gestation, while receiving weekly meal deliveries. Data from both visits will be used for the purpose of this study. Women’s social support will be measured using the Multidimensional Scale of Perceived Social Support. While stress will be measured via the Perceived Stress Scale. Results/Anticipated Results: Previous behavioral weight loss studies have found that individual who endorse experiencing social support report less perceived stress. Although the relationship has seldomly been examined in pregnant women, similar results are anticipated. Often aid, such as meal delivery, can impact perceived stress and is likely to cause a positive change. To our knowledge, this is the first study to explore whether social support mediates the changes in perceived stress after receiving weekly meal delivery. Therefore, there is no known literature to suggest anticipatory results. Discussion/Significance of Impact: Few studies have examined the association between social support and perceived stress in pregnant women. This study will examine the effects social support has on a pregnant women’s stress. The proposed study will aim to identify if meal delivery changes perceived stress. If so, the study will explore if perceived social support mediates this change.

Abstract Context The effects of physiological improvements on cognitive function among persons with type 2 diabetes mellitus (T2DM) are not fully understood. Objective To determine whether improvements in physiological markers (body weight, blood sugar control, and physical activity) during intensive lifestyle intervention (ILI) are associated with enhancements in cognitive function in older adults with T2DM. Design Multisite randomized controlled trial. Setting Academic research centers. Patients or Other Participants Participants were aged 45–76 years, with T2DM. Intervention The Action for Health in Diabetes (Look AHEAD) study, a randomized, controlled clinical trial of ILI. Main Outcome Measure Two to 3 cognitive assessments were collected from 1089 participants, the first and last occurring a mean (standard deviation) of 8.6 (1.0) and 11.5 (0.7) years after enrollment. Results Greater improvement in blood sugar control was associated with better cognitive scores (fasting glucose and Rey Auditory Verbal Learning Test [AVLT]: P = 0.0148; fasting glucose and Digit Symbol Coding (DSC): P = 0.0360; HbA1C and DSC: P = 0.0477); but weight loss had mixed associations with cognitive scores (greater body mass index [BMI] reduction and worse AVLT overall: P = 0.0053; and greater BMI reduction and better DSC scores among those overweight but not obese at baseline: P = 0.010). Associations were strongest among those who were overweight (not obese) at baseline, and among those with a history of cardiovascular disease (CVD) at baseline. Conclusions Improvements in glycemic control, but not necessarily weight status, during ILI may be associated with better subsequent cognitive performance. These associations may differ by adiposity and CVD history.

Background Behavioral interventions for obesity produce clinically meaningful weight loss, but weight regain following treatment is common. Extended care programs attenuate weight regain and improve weight loss maintenance. However, less is known about the most effective ways to deliver extended care, including contact schedules. Methods We compared the 12-month weight regain of an extended care program utilizing a non-conventional, clustered campaign treatment schedule and a self-directed program among individuals who previously achieved ≥5% weight reductions. Participants ( N  = 108; mean age = 51.6 years; mean weight = 92.6 kg; 52% African American; 95% female) who achieved ≥5% weight loss during an initial 16-week behavioral obesity treatment were randomized into a 2-arm, 12-month extended care trial. A clustered campaign condition included 12 group-based visits delivered in three, 4-week clusters. A self-directed condition included provision of the same printed intervention materials but no additional treatment visits. The study was conducted in a U.S. academic medical center from 2011 to 2015. Results Prior to randomization, participants lost an average of −7.55 ± 3.04 kg. Participants randomized to the 12-month clustered campaign program regained significantly less weight (0.35 ± 4.62 kg) than self-directed participants (2.40 ± 3.99 kg), which represented a significant between-group difference of 2.28 kg ( p  = 0.0154) after covariate adjustments. This corresponded to maintaining 87% and 64% of lost weight in the clustered campaign and self-directed conditions, respectively, which was a significant between-group difference of 29% maintenance of lost weight after covariate adjustments, p  = 0.0396. Conclusions In this initial test of a clustered campaign treatment schedule, this novel approach effectively promoted 12-month maintenance of lost weight. Future trials should directly compare the clustered campaigns with conventional (e.g., monthly) extended care schedules. Trial registration Clinicaltrials.gov NCT02487121 . Registered 06/26/2015 (retrospectively registered)

Background Intervention packages targeting obesity-related conditions often include multiple behavioral and pharmacological components, yet the independent and synergistic effects of these strategies on disease progression remain largely unexplored. Adaptive interventions offer a structured approach to tailoring treatments based on individual responses, but feasibility data in primary care settings are limited. The objective of this pilot Sequential Multiple Assignment Randomized Trial (SMART) was to investigate the feasibility of a 25-week adaptive biobehavioral intervention designed to improve insulin sensitivity among patients with stage 1 obesity. Methods Forty participants were initially randomized to either nutrition counseling (NC) or exercise counseling (EC), both employing a weight-neutral approach. At week 8, insulin sensitivity was reassessed using the Quantitative Insulin Sensitivity Check Index (QUICKI). Participants with a > 5% improvement were classified as responders, while non-responders were re-randomized to either augment their first-stage intervention with metformin or switch to weight loss counseling (WLC). Feasibility outcomes included recruitment and retention, adherence to intervention components, and preliminary treatment effect estimates. Results Findings support the overall feasibility of the SMART design, with high adherence to virtual counseling sessions and favorable participant retention. The study effectively differentiated responders from non-responders at week 8, with responders showing greater improvements in insulin sensitivity. Among non-responders, WLC and metformin provided a potential rescue effect, but overall insulin sensitivity remained lower than at of responders. While NC and WLC were preferred over EC and metformin, adherence to counseling sessions remained high across all interventions, regardless of preference. Metformin adherence posed challenges due to frequent gastrointestinal side effects and difficulties tracking usage. Conclusions This pilot study supports the feasibility of an adaptive biobehavioral intervention for improving insulin sensitivity among adults with obesity in a primary care setting. However, further refinement is needed to enhance clinical integration, optimize intervention messaging, and improve medication tracking. Findings from this study will inform a second pilot SMART, laying the foundation for a full-scale primary-care embedded intervention delivering personalized, adaptive strategies for improving cardiometabolic health. Trial registration NCT04392283 on April 19th, 2020.

The Deep South has the highest rates of obesity, diabetes, and hypertension in the nation, with marked disparities by race, socioeconomic status, and rurality. The mission of the Forge AHEAD Center is to improve health outcomes and reduce the burden of cardiometabolic diseases across the Deep South, with a particular focus on the prevention and treatment of these chronic diseases. Forge AHEAD is unified thematically by its application of a precision public health approach across the care continuum, defined as delivering the right intervention to the right population at the right time. This approach acknowledges the importance of context and individual beliefs and preferences, as well as the need for multi-level and multi-domain interventions to achieve health improvements. The Center brings together an interdisciplinary team of investigators from 4 institutions in 3 contiguous states in the region, as well as non-academic partners to extend cardiometabolic research into real-world community and clinical settings. Given the high prevalence of cardiometabolic diseases in the Deep South and the strong research base of the partnering institutions, the Forge AHEAD Center is ideally situated to inform research, clinical care, and policy to improve health outcomes in a region of substantial need.

Objectives/Goals: Arterial stiffness is a determinant of vascular health. Older Black females exhibit greater arterial stiffness than White females. Exercise minimizes negative health effects of prolonged exposure to adverse social determinants of health (SDoH). Here, we will assess the role of exercise on race differences in arterial stiffness and SDoH in females. Methods/Study Population: We will recruit 96 postmenopausal females (48 Black, 48 White) from the Birmingham, AL area. Graded exercise tests will be used to define training status (“trained”: VO2max ≥60th percentile, “untrained”: ≤35th percentile). We will assess arterial stiffness via pulse wave velocity (SphygmoCor XCEL). SDoH will include income, education, neighborhood deprivation, racial discrimination, food insecurity, and healthcare access, all measured via corresponding surveys. We will then perform a two-way analysis of variance (race × training status) to assess the differences in arterial stiffness between groups. Through linear regression, we will evaluate the statistical relations between arterial stiffness and race, training status, and SDoH. Results/Anticipated Results: Our central hypothesis is that Black females will have greater arterial stiffness, by way of greater exposure to adverse SDoH, than White females, but that habitual aerobic exercise will attenuate this race difference. Ultimately, we aim to inform future clinical trials related to understanding female-specific cardiovascular disease progression. Discussion/Significance of Impact: Black females face significant exposure to adverse SDoH and have the highest rates of cardiovascular disease in the United States. However, females are still widely underrepresented in relevant research. This will be the first study to examine the roles of aerobic exercise, race, and SDoH in cardiovascular disease risk among females.

Objectives/Goals: Heart disease is a leading cause of death in Alabama. Non-Hispanic Black (NHB) women demonstrate greater arterial stiffness than Non-Hispanic White (NHW) women. We explored whether cardiorespiratory fitness (VO2max) accounts for population differences in arterial stiffness among postmenopausal women. Methods/Study Population: We analyzed data from 57 postmenopausal women (65% NHB; age: 62±8 years; BMI: 28±4 kg/m 2 ; blood pressure: 136±17/80±9 mmHg). VO2max was measured using maximal treadmill testing (Modified Bruce Protocol) and arterial stiffness (pulse wave velocity, PWV) via SphygmoCor XCEL. We used bias-corrected bootstrapped mediation models (5,000 resamples) to estimate the indirect effect of ancestry on PWV via VO2max, adjusting for age, body mass index, lived experience, adverse childhood exposures, and neighborhood deprivation. Given the small sample size, these analyses are exploratory. Results/Anticipated Results: NHB women had significantly lower VO2max than NHW women (18.0±3.7 vs. 23.8±4.5 mL•kg −1 •min −1 ). VO2max was inversely associated with PWV (B = -0.10, SE = 0.04, p = 0.02, 95% CI = −0.19 to −0.01). After adjustment, ancestry was not directly associated with PWV. Neighborhood deprivation (B = 0.16, SE = 0.07, p = 0.02, 95% CI = 0.03 to 0.29) and lived experience (B = 0.10, SE = 0.04, p = 0.03, 95% CI = 0.01 to 0.19) were associated with higher PWV, even after adjusting for VO2max and risk factors. In bootstrapped mediation models, the indirect effect of ancestry on PWV through VO2max was significant (B = 0.35, SE = 0.19, 95% BCa CI = 0.03 to 0.78), consistent with partial mediation. Discussion/Significance of Impact: Cardiorespiratory fitness appears to partly account for population differences in arterial stiffness, but this cross-sectional analysis with a modest sample is exploratory. Targeting both fitness and upstream socioeconomic factors may be needed to reduce differences in women’s vascular health.

The purpose of this systematic review was to evaluate, synthesize, and interpret findings from recent randomized controlled trials (RCTs) of dietary and lifestyle weight loss interventions examining the effects of (1) diet composition, (2) use of food provision, and (3) modality of treatment delivery on weight loss. Trials comparing different dietary approaches indicated that reducing carbohydrate intake promoted greater initial weight loss than other approaches but did not appear to significantly improve long-term outcomes. Food provision appears to enhance adherence to reduction in energy intake and produce greater initial weight losses. The long-term benefits of food provision are less clear. Trials comparing alternative treatment modalities suggest that phone-based treatment produce short- and long-term weight reductions equivalent to face-to-face interventions. The use of Internet and mobile technologies are associated with smaller reductions in body weight than face-to-face interventions. Based on this review, clinical implications and future research directions are provided.