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Obesity is a modifiable risk factor for urinary incontinence. This study randomly assigned overweight and obese women with urinary incontinence to an intensive 6-month weight-loss program or to a structured education program. More intervention-group participants had clinically relevant reductions in the frequency of episodes of any incontinence, stress incontinence, and urge incontinence. This study randomly assigned overweight and obese women with urinary incontinence to an intensive 6-month weight-loss intervention or to a structured education program. More intervention-group participants had clinically relevant reductions in the frequency of episodes of any incontinence, stress incontinence, and urge incontinence. Urinary incontinence affects more than 13 million women in the United States and has been associated with profound adverse effects on quality of life 1 , 2 ; an increased risk of falls, fractures, 3 and nursing-home admissions 4 ; and more than $20 billion in estimated annual direct health care costs. 5 Observational studies suggest that obesity is a strong risk factor for urinary incontinence, 6 – 9 and preliminary studies suggest that weight loss may have a beneficial effect on urinary incontinence in obese patients. 10 – 14 Reductions in urinary incontinence have been observed in morbidly obese women who have had dramatic weight loss after bariatric . . .

To describe the feasibility, acceptability and results of Strong Families Start at Home, a 6-month pilot trial of a home-based food parenting/nutrition intervention. Pilot randomised controlled trial. Participants received six visits with a community health worker trained in motivational interviewing (three home visits, three phone calls); an in-home cooking or reading activity; personalised feedback on a recorded family meal or reading activity; text messages and tailored printed materials. Parents and their 2-5-year-old child were randomised into intervention (responsive food parenting practices/nutrition) or control (reading readiness) groups. Parents ( 63) were mostly mothers (90 %), Hispanic/Latinx (87 %), born outside the USA (62 %), with household incomes <$25 k (54 %). Despite delivery during COVID-19, 63 % of dyads were retained at 6 months. The intervention was delivered with high fidelity. All parents in the intervention group ( 24) expressed high levels of satisfaction with the intervention, which produced positive treatment effects for whole and total fruit component Healthy Eating Index-2015 scores (point estimate (PE) = 2·14, 95 % CI (0·17, 1·48); PE = 1·71, 95 % CI (0·16, 1·47), respectively) and negative treatment effects for sodium (PE = -2·09, 95 % CI (-1·35, -0·04)). Positive treatment effects also resulted for the following food parenting practices: regular timing of meals and snacks (PE = 1·08, 95 % CI (0·61, 2·00)), reducing distractions during mealtimes (PE = -0·79, 95 % CI (-1·52, -0·19)), using food as a reward (PE = -0·54, 95 % CI (-1·35, -0·04)) and providing a supportive meal environment (PE = 0·73, 95 % CI (0·18, 1·51)). Given the continued disparities in diet quality among low-income and diverse families, continued efforts to improve child diet quality in fully powered intervention trials are needed.

Research suggests that a disproportionate number of female individuals being treated for an eating disorder (ED) also have autism spectrum disorder (ASD). Alexithymia, or difficulty identifying and describing emotions, may mediate the relationship between ED and ASD. In this study, we explored the association of autistic traits with symptoms of alexithymia and eating pathology, as well as the potential mediating role of alexithymia. Two hundred and twenty‐eight female participants aged 18 and older were recruited from online ED support platforms to complete an anonymous online survey via Qualtrics. The survey included three questionnaires: the Toronto Alexithymia Scale‐20, the Autism‐Spectrum Quotient (AQ), and the 13‐item Eating Disorder Examination Questionnaire. More than half (54.8%) of participants met the clinical threshold on the AQ. Participants with a positive screen on the AQ scale also reported more symptoms of alexithymia (92.6% of individuals with a positive AQ vs. 79.8% of those without), B  = 9.02, p  < 0.001. A positive AQ screen was also associated with significantly greater disordered eating symptoms, B  = 4.26, p  = 0.031. Alexithymia mediated this association, a  ×  b  = 1.98, p  < 0.05. The results establish a strong positive relationship between autistic traits and alexithymia, supporting previous data and suggesting that autistic female individuals struggle to identify emotions. Additionally, alexithymia served as a mediator between autistic traits and disordered eating. Understanding this relationship may help inform the treatment of autistic female individuals who are also struggling with ED.

Background Obesity risk is shared between spouses, yet existing weight loss programs focus on individuals and not the marital dyad. Given the interdependence of weight in couples, weight management outcomes might be improved by targeting joint weight loss and the creation of an interpersonal milieu that supports long-term behavior change. According to Self-Determination Theory (SDT), greater autonomous self-regulation of behaviors, and subsequently better treatment outcomes, are observed in needs supportive environments in which personally meaningful choice is supported and criticism and control are minimized. Correlational analyses confirm these pathways in weight management, with needs support from one’s spouse or partner emerging as a distinct predictor of weight loss success. Research is now needed to establish causal links and to develop and test weight loss interventions designed to facilitate the needs supportive behavior of spouses. Methods Project TEAMS (Talking about Eating, Activity, and Mutual Support) is a randomized controlled trial testing a couples-based intervention, grounded in SDT, designed to change the social context of weight loss by training spouses to provide needs support for each other’s eating and physical activity behavior. Sixty-four couples will be randomized to either 6 months of behavioral weight loss treatment informed by SDT (SDT-WL) or to 6 months of standard behavioral weight loss treatment (BWL). Couples will attend weekly sessions for 6 months and will be assessed at 0, 3, 6, and 12 months. By bolstering needs support, SDT-WL is predicted to increase autonomous self-regulation and perceived competence and produce greater weight loss and maintenance than standard behavioral treatment. Exploratory analyses will examine the SDT process model prediction that the influence of needs support on treatment outcomes will be mediated by autonomous self-regulation and perceived competence. Discussion This study addresses the fundamental importance of interpersonal support in weight management by focusing on couples rather than individuals and using a rich theoretical framework to train spouses in supportive behaviors. Trial registration Clinicaltrials.gov ; NCT02570009 .

Objective Behavioral weight management trials are traditionally conducted in‐person. The COVID‐19 shutdown halted in‐person operations, forcing investigators to develop new methods for remote treatment and assessment delivery without additional funding for website development or remote equipment. This study examined the feasibility and acceptability of remote procedures from an ongoing weight management trial impacted by COVID‐19. Methods Using a quasi‐experimental longitudinal design, in‐person (pre‐COVID) and remote (COVID) treatment and assessment procedures were used. Attendance at in‐person versus remote (videoconference) treatment sessions was compared. Acceptability of treatment modalities (in‐person vs. remote) was examined via self‐report. Validity and reliability were assessed on bathroom scales. Attendance at remote (videoconference + mailed, scales) versus in‐person assessment sessions was compared. Finally, exploratory analyses were conducted to determine whether participant characteristics moderated the effects. Results Remote treatment attendance was significantly better than in‐person. Overall, there was no significant difference in modality preference. However, Hispanic (vs. non‐Hispanic) individuals had greater preference for remote options and attended more remote treatment sessions. Bathroom scales demonstrated excellent validity and reliability. Adherence to remote and in‐person assessment sessions was similar. Conclusions COVID‐19 has provided an opportunity to rethink how we conduct research. Results herein establish an evidence‐base to support a paradigm shift to remote clinical trial procedures. Such a shift may enhance diversity in clinical trials. COVID‐19 has provided an unprecedented opportunity to rethink how we conduct research. Results from this study establish an evidence‐base to support a paradigm shift to remote clinical trial procedures for behavioral weight management using widely available technology. Such a shift may enhance diversity in our clinical trials and generalizability of treatment results.Online behavioral weight loss coach

Objective Adaptive interventions may improve the potency and scalability of behavioral weight loss interventions, but the treatments—or treatment combinations—that should be offered are unknown. A two‐stage pilot sequential multiple assignment randomized trial was used to test the timing and dose of human support added to a core digital weight loss program. Methods In stage 1, 99 adults with overweight/obesity were randomized at baseline to a kick‐off with or without additional human support. In stage 2, “early non‐responders” who had not achieved a 2% weight loss were re‐randomized after 4 weeks to either biweekly counseling (120 min over 8 weeks) or a one‐time check‐in (30 min) with a dietitian. “Early responders” continued with the mHealth program alone. Feasibility and acceptability were assessed against pre‐specified criteria. Preliminary outcomes (weight loss, self‐monitoring and behavioral goal adherence) were explored. Results The study met all feasibility and acceptability criteria. The rate of early response was 52.5%. Mean (SE) 3‐month percent weight losses were significantly greater in early responders (−6.63% (0.72)) than non‐responders (−1.70% (0.43), p < 0.001). Outcomes were similar by first‐ and second‐line treatment though more counseling (27.3%) than check‐in (12.5%) participants achieved a 5% weight loss. Conclusions Identifying early responders may help optimize weight loss interventions, but more research is needed on rescue treatments for early non‐responders. Trial Registration ClinicalTrial.gov, NCT05929469.

Objective To determine the feasibility of recruiting and retaining young adults in a brief behavioral weight loss intervention tailored for this age group, and to assess the preliminary efficacy of an intervention that emphasizes daily self-weighing within the context of a self-regulation model. Methods Forty young adults (29.1 ± 3.9 years, range 21–35, average BMI of 33.36 ± 3.4) were randomized to one of two brief behavioral weight loss interventions: behavioral self-regulation (BSR) or adapted standard behavioral treatment (SBT). Assessments were conducted at baseline, post-treatment (10 weeks), and follow-up (20 weeks). Intent to treat analyses were conducted using general linear modeling in SPSS version 14.0. Results Participants in both groups attended an average of 8.7 out of 10 group meetings, and retention rates were 93% and 88% for post-treatment and follow-up assessments, respectively. Both groups achieved significant weight losses at post-treatment (BSR = -6.4 kg (4.0); SBT = -6.2 kg (4.5) and follow-up (BSR = -6.6 kg (5.5); SBT = -5.8 kg (5.2), p < .001; but the interaction of group × time was not statistically significant, p = .84. Across groups, there was a positive association between frequency of weighing at follow-up and overall weight change at follow-up ( p = .01). Daily weighing was not associated with any adverse changes in psychological symptoms. Conclusion Young adults can be recruited and retained in a behavioral weight loss program tailored to their needs, and significant weight losses can be achieved and maintained through this brief intervention. Future research on the longer-term efficacy of a self-regulation approach using daily self-weighing for weight loss in this age group is warranted. Clinical Trials Registration # NCT00488228

Objective. Little is known about the impact of loneliness on physical health among elderly individuals with diabetes. Here, we examined the relationship of loneliness with disability, objective physical function, and other health outcomes in older individuals with type 2 diabetes and overweight or obesity. Method. Data are drawn from the Look AHEAD study, a diverse cohort of individuals (ages 61–92) with overweight or obesity and type 2 diabetes measured 5–6 years after a 10-year weight loss randomized, controlled trial. Results. Loneliness scores were significantly associated with greater disability symptoms and slower 4-meter gait speed (ps<0.01). Loneliness did not differ across treatment arms. Discussion. Overall, these results extend prior findings relating loneliness to disability and decreased mobility to older individuals with type 2 diabetes and overweight or obesity.

Weight loss maintenance is a complex, multifaceted process that presents a significant challenge for most individuals who lose weight. A growing body of literature indicates a strong relationship between cognitive dysfunction and excessive body weight, and suggests that a subset of high-order cognitive processes known as executive functions (EF) likely play an important role in weight management. Recent reviews cover neuropsychological correlates of weight status yet fail to address the role of executive function in the central dilemma of successful weight loss maintenance. In this paper, we provide an overview of the existing literature examining executive functions as they relate to weight status and initial weight loss. Further, we propose a novel conceptual model of the relationships between EF, initial weight loss, and weight loss maintenance, mapping specific executive functions onto strategies known to be associated with both phases of the weight control process. Implications for the development of more efficacious weight loss maintenance interventions are discussed.

Summary Background Emerging adults (ages 18–25) are at high risk for overweight/obesity, yet traditional adult behavioural weight loss (BWL) interventions do not meet the needs of individuals at this developmental stage. Motivational interviewing (MI) is an evidence‐based approach to promote behaviour change but has not been tested for weight loss in this population. The study aimed to test the feasibility and preliminary efficacy of an MI‐enhanced weight loss programme to promote engagement, retention and weight loss in emerging adults. Methods Emerging adults with overweight/obesity (N = 47, 81% female, 47% racial/ethnic minority, body mass index [BMI] = 33.2 ± 4.6 kg/m2) were randomized to either standard BWL or MI‐enhanced BWL (MIBWL). Weight was assessed objectively at baseline and posttreatment (3 months). Engagement (in‐person session attendance [weeks 1 and 2], online self‐monitoring [weeks 3–12] and online content viewing [weeks 3–12]) was tracked throughout the program. Results Though results did not reach the level of statistical significance, participants in MIBWL demonstrated greater programme engagement (77% vs. 61.0%, p = .11; Cohen d = .48), retention (71% vs. 48.0%, p = .10; Cohen h = .47) and intent‐to‐treat weight loss (−3.3% vs. −2.2%, p = .37; Cohen d = .26) compared with those in BWL. Conclusions Effect sizes suggest that MI might be a viable approach to enhance engagement and retention in weight loss programmes targeting emerging adults. This finding is meaningful, given the documented challenges with engagement and retention in this vulnerable population and the relationship between engagement and better weight loss outcomes. The results of this small pilot study support efforts to replicate these findings within the context of a fully powered trial.