Lorraine Lanningham-Foster, Ph.D.
Endocrine Research Unit
Mayo Clinic, Rochester, MN
Children are becoming less physically active and consuming more calories in their diets. This shift to inactivity and increased food consumption patterns is associated with increased obesity in children. Factors related to obesity in children include the amount of time spent in physical or sedentary activity and the energy-expenditure (EE) of activity. In adults, it has been demonstrated that increases in non-exercise activity thermogenesis (NEAT) predict resistance to fat gain in non-obese individuals. The role of NEAT in pediatric obesity has not been evaluated and may prove to also play a key role in modulating weight gain in children and the genesis of obesity in adults.
This study will investigate physical activity in pediatric obesity using unique instruments developed in our laboratory. In examining the components of NEAT in children, our hypothesis in the first specific aim is that the EE associated with walking is the primary predictor of NEAT. Alternatively, other components of NEAT (fidgeting) may contribute more to EE than walking in children as compared to adults. We will measure this as well. In specific aim 2, we will investigate the effect of body weight change on NEAT in lean prepubescent children. Our hypothesis in the second specific aim is that prepubescent children will have decreased NEAT with an artificially imposed increase in body weight. Together, these studies will provide insight into the role of physical activity in the pathogenesis of pediatric obesity. The data collected in the proposed studies will be used as preliminary data for an initial R01 grant application in the area of pediatric physical activity and obesity.
Nancy E. Sherwood, Ph.D.
HealthPartners Research Foundation, Minneapolis, MN
Long term weight loss maintenance remains the most critical challenge for obesity treatment. Extending the length of clinic-based treatment has been shown to improve maintenance and key behaviors for successful maintenance have been identified. Treatment studies have incorporated such strategies; however, the most intensive phase of treatment typically occurs during weight loss initiation with the maintenance phase occurring after treatment novelty has faded. Although increasing treatment duration improves weight loss, there is a point of diminishing returns as people eventually stop attending sessions. Recruiting participants who have recently lost weight to a maintenance intervention may be a viable alternative strategy.
The optimal mode and timing of maintenance intervention delivery are key issues. One conceptual framework suggests that maintenance will be enhanced by teaching people about key behaviors required for weight loss maintenance and assisting them with the development of these habits. This model suggests that a maintenance program would best be designed similar to a standard weight loss intervention where intervention components addressing maintenance-specific behaviors are delivered to participants on a pre-set schedule.
An alternative model recognizes that maintenance is a process that inevitably includes periods of weight regain; the likelihood of maintenance will be increased to the extent that individuals pro-actively respond to setbacks by using strategies to reverse small weight gains. This model suggests that interventions should be delivered in response to participants' progress in weight management, providing personalized assistance when it is most needed.
The goal of this study will be to develop and pilot-test two interventions designed to promote weight loss maintenance among participants in a managed care (MCO) setting who have recently lost weight. Study subjects will include HealthPartners (HP) members who are age 19 and older who have lost >5% of their body weight during the previous calendar year. Primary goals of this pilot study will be to learn about the best strategies for recruiting participants who have recently lost weight. To this end, several strategies will be used including mailings (e.g., articles in HP-wide newsletters, letters) and clinic-based recruitment.
Sixty HP members who have recently lost weight and complete baseline measurements will be randomized to either
"usual care" (UC);
a "scheduled" maintenance intervention (SMI); or
a "personalized" maintenance intervention (PMI). Participants will complete a survey and have their body weight measured again at 6-month follow-up.
Although the small number of participants in the pilot study and the relatively short length of follow-up will limit our ability to detect statistically significant treatment group differences, trends will be examined by comparing the amount of weight lost at follow-up in each of the two treatment groups to weight lost in the comparison group. Results of this pilot study will be used as feasibility data supporting a larger NIH grant application proposing the implementation of a full-scale randomized trial evaluating the efficacy of the two weight maintenance interventions in comparison to usual care over 2 years.
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