Modifying Obesogenic Homes: Impact on Weight Maintenance NHLBI HL077082

1. Modifying Obesogenic Homes: Impact on Weight MaintenanceNHLBIHL077082 Investigators: Amy Gorin (PI), Rena Wing, Hollie Raynor, Joseph Hogan Project Staff: Kimberley Chula Maguire (Project Director), Erica Ferguson, Jen Trautvetter, Dylan Wykes, Elizabeth Jackvony, Pam Coward, Melissa Crane, Mike Gutierrez, Jill Donnelly

2. Obesity Trends Among U.S. Adults2005 (BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Behavioral Risk Factor Surveillance System, CDC.

3. CVD Diabetes Gallbladder disease Respiratory disease Arthritis Cancer ________________________ $60+ billion in direct medical costs and 100,000+ deaths each year Health Impact of Excessive Weight

4. Behavioral Weight Control Antecedents Behavior Consequences • Self-monitoring • Stimulus control • Problem solving • Social support • Goal setting • Cognitive restructuring • Relapse prevention

5. The Good News… Modest weight losses (5-10% of body weight) and increases in physical activity can decrease the risk of diabetes and other health problems by more than 50%

6. The Bad News… Wadden et al., 1989 Treatment Follow-up TIME IN WEEKS

7. An Ecological Model of Obesity (NHLBI) Influences Behaviors Health Outcomes Biological & Demographic Age, sex, race/ethnicity, SES, genes Eating Dietary patterns, nutrient intake Psychological Beliefs, preferences, emotions, self-efficacy, intentions, pros, cons, behavior change skills, body image, motivation, knowledge Social/Cultural Social support, modeling, family factors, social norms, cultural beliefs, acculturation Sedentary Behaviors TV, computer use, driving Weight, Fat, & Distribution Energy Balance Organizational Practices, programs, norms, & policies in schools, worksite, Health care settings, businesses, community orgs Physical Environment Access to & quality of foods, recreational facilities, cars, sedentary entertainment; urban design, transportation infrastructure, information environment Physical Activity Recreation, transportation, occupation, domestic Risk Factors, CVD, Diabetes, Cancers, Costs Policies/Incentives Cost of foods, physical activities, & sedentary behaviors; incentives for behaviors; regulation of environments Developed for the NHLBI Workshop on Predictors of Obesity, Weight Gain, Diet, and Physical Activity; August 4-5, 2004, Bethesda MD

8. An Ecological Model of Obesity (NHLBI) Influences Behaviors Health Outcomes Biological & Demographic Age, sex, race/ethnicity, SES, genes Eating Dietary patterns, nutrient intake Psychological Beliefs, preferences, emotions, self-efficacy, intentions, pros, cons, behavior change skills, body image, motivation, knowledge Social/Cultural Social support, modeling, family factors, social norms, cultural beliefs, acculturation Sedentary Behaviors TV, computer use, driving Weight, Fat, & Distribution Energy Balance Organizational Practices, programs, norms, & policies in schools, worksite, Health care settings, businesses, community orgs Physical Environment Access to & quality of foods, recreational facilities, cars, sedentary entertainment; urban design, transportation infrastructure, information environment Physical Activity Recreation, transportation, occupation, domestic Risk Factors, CVD, Diabetes, Cancers, Costs Policies/Incentives Cost of foods, physical activities, & sedentary behaviors; incentives for behaviors; regulation of environments Developed for the NHLBI Workshop on Predictors of Obesity, Weight Gain, Diet, and Physical Activity; August 4-5, 2004, Bethesda MD

9. Overweight and obese (BMI 25-50 kg/m2) adults randomly assigned to 18 months of: 1) standard behavioral treatment 2) SBT + direct manipulation of physical and social home environment

10. Goal 1: Modify the type and portion sizes of foods consumed in the home • Alter food cues in the home • Cabinet Cleanouts and Filling up with Fit Foods • Subscription to healthy eating magazine • Motivational posters • Control portions of meals consumed in home • Serving size appropriate plates and glasses • Food provision via Peapod • In pilot study, this decreased % of high fat foods in the home from 27% to 17%, significantly more than SBT

11. Goal 2: Modify the availability of exercise equipment and sedentary activities in the home • Provision of treadmill or exercise bike • Enhancing visual cues for exercise • Subscription to exercise magazine • Motivational posters • Decreasing cues for sedentary activity • Limiting access to TVs with TV Allowance • In pilot, reduced household TV time by 50%

12. Goal 3: Increase the saliency of the consequences of eating and exercise choices • Provided with digital scale and full length mirror • Instructed to place items in prominent locations in home

13. Goal 4: Create a positive model for healthy eating and exercise in the home • Required to bring an overweight, adult partner who lives in the same house to treatment • Partner sets weight loss goal and makes similar changes in eating and exercise • Based on prior work showing that bringing a partner is only effective when the partner is also successful

14. LEAP Study Outcomes • Participants and partners assessed at 0, 6, 12, and 18 m; • Weight • Weight-related behaviors • Dietary intake • Physical activity • TV viewing • Other variables • Depression • Quality of life • Reasons for wanting to lose weight • Alcohol use and smoking

15. Physical home environment Type and placement of food Type and placement of exercise equipment # of TVs TV in the bedroom Scale, full length mirror Healthy eating and exercise magazines Social home environment Type of support (autonomous vs. controlled) from partner Household support – how supportive each person is of participant’s weight control efforts and whether or not they are interested in changing their own eating and exercise Sallis Support Measure Assessing the Home Environment Home visits at 0, 6, and 18 m

16. Study Progress • Recruitment 201 pairs (402 individuals) enrolled in the study 50.5+10.8 years 78.6% women 21.4% minority participation • Retention 97% at 6 m 89% at 12 m 95% at 18 m (2 out of 6 waves completed)