Obesity, the official journal of The Obesity Society, has selected two papers as Editors’ Choice articles for its October 2018 issue. The Editors’ Choice articles are hand-picked by the journal’s editors and both papers focus on obesity intervention research done by researchers at University of Tennessee Health Science Center (UTHSC) for active duty military personnel in San Antonio, Texas.
One paper entitled, “Dissemination of the Look AHEAD intensive lifestyle intervention in the United States military: A randomized controlled trial” which was authored by Rebecca A. Krukowski, PhD, associate professor in the Department of Preventive Medicine at UTHSC, compared a self-paced weight loss program to a counselor-initiated weight loss program. Despite the significant societal and personal repercussions of overweight and obesity in the military, few behavioral weight loss programs with military personnel have used the strongest study design, the randomized controlled trial.
The Fit Blue research study randomized participants into two 12-month phone and email-based programs: one counselor-initiated and one self-paced. Both programs were based on a translation of the Look AHEAD Intensive Lifestyle Intervention, which was originally designed to induce weight loss in a diverse population with diabetes, and the study results were significant.
“30 percent of participants in the counselor initiated condition and 16 percent of participants in the self-paced condition achieved clinically significant weight loss, which means that they reached the threshold at which people start to experience health benefits of weight loss,” Dr. Krukowski said. “In addition, the waist circumference changes, 1.1 inch in the counselor-initiated condition and 0.7 inches in the self-paced condition, can be really important for helping these active duty military personnel pass a fitness test which is part of their annual performance report.”
The counselor-initiated intervention program produced the largest weight losses to date in a randomized controlled trial among military personnel. Dr. Krukowski explained that the study results are consistent with the hypothesis that the counselor-initiated group would see greater weight loss results, a nod to the common perception that you are more likely to experience positive weight loss results if you have an accountability partner, like their interventionists, who provided support, problem solving assistance, and feedback.
Dr. Krukowski worked on the Fit Blue study and paper with several other collaborators at UTHSC including Mehmet Kocak, PhD, Karen C. Johnson, MD, MPH, Phyllis Richey, PhD, and Marion Hare, MD, as well as military collaborators and collaborators now at the University of Virginia.
The second paper entitled, “Changes in the perceptions of self-weighing across time in a behavioral weight loss intervention,” addresses changes in people’s beliefs about self-weighing across time and features authors from UTHSC and the University of Virginia as well as first author Margaret C. Fahey, MA, of the University of Memphis who completed a research assistantship at UTHSC.
“We know that self-weighing is an important strategy for success in weight management, like checking your account balance at the ATM so you know whether you should be frugal or if you can be a bit more relaxed about money,” Dr. Krukowski said. However, she explained that there have been some lingering concerns that self-weighing might increase feelings of frustration, anxiety, or self-consciousness. To test this, Dr. Krukowski and her team examined changes in perceptions of self-weighing during the weight loss and weight maintenance phases of a weight loss intervention in active duty military personnel.
“Other studies have looked at feelings of self-weighing at the end of treatment, but never looked at change over the course of treatment. We found that after the program participants indicated that self-weighing was more positive, more helpful, and less frustrating than before the program. For those individuals in the more intensive version of the intervention, we saw even more positive views of self-weighing.”
When asked if she was surprised by the study results, Dr. Krukowski explained the main findings were consistent with their hypothesis. “I was surprised, however, that those who engaged in less self-weighing before the intervention had more positive views of self-weighing at the end of the intervention. This could be individuals who are reluctant to self-weigh because of the emotions that they have when they do or individuals who just haven’t tried self-weighing as a strategy much. When they tried it as a strategy, they found it more helpful, more positive, and less frustrating than what they were expecting.”