Inês Santos

Background: Digital approaches to weight management have the potential to produce cost-effective and scalable weight management solutions. Effective behavior change interventions typically promote self-regulation of energy balance behaviors, which may be enhanced by incorporating emotion regulation strategies. Objective: This study aimed to evaluate the effectiveness of a digital behavior change toolkit for weight loss maintenance in European adults who had achieved ≥5% weight loss in the previous 12 months. We hypothesized that a combined intervention targeting self-regulation or motivation and emotion regulation would be more effective than either component alone, and that each would outperform an active control. Methods: The Navigating to a Healthier Weight (NoHoW) trial was a 2×2 factorial randomized, single-blind, controlled trial involving 1627 adults who had achieved ≥5% weight loss in the previous 12 months (initial BMI ≥25 kg/m ² ) across 3 European centers (the United Kingdom, Denmark, and Portugal). The trial evaluated a digital toolkit for weight management subsequent to an initial ≥5% weight loss in the prior 12 months. Participants were assigned using adaptive stratified sampling to one of four groups: (1) self-regulation or motivation (n=403), (2) emotion regulation (n=416), (3) combined motivation and emotion (n=408), or (4) active control (generic content, regular self-weighing, and Fitbit use, n=400). The primary outcome was weight change from baseline to 12 months. Prespecified secondary outcomes included cardiometabolic markers. Linear models adjusted for recruitment center, sex, age group, BMI group, and pretrial weight loss. Subgroup analyses were conducted by sex. Results: At 12 months, 76% (364/1627) of participants remained in the study. In the primary ITT analysis in all participants, none of the intervention arms (motivation, emotion, or combined) differed significantly from the active control for weight change at 12 months. Completer and per-protocol analyses produced similar patterns and did not change the overall interpretation. In the per-protocol sample, men regained 0.14 kg, and women regained 0.54 kg of their pretrial weight loss. Subgroup analyses indicated a small effect of the motivation intervention in men, but this was not clinically meaningful and did not alter the primary null findings. Nearly half of ITT participants regained weight, and no significant intervention effects were observed for cardiometabolic secondary outcomes. Conclusions: The NoHoW trial was the first large-scale, multicountry 2×2 factorial randomized controlled trial to evaluate a digital-only toolkit based on self-regulation or motivation and emotion regulation techniques for weight loss maintenance. NoHoW found no evidence in the primary ITT analysis that digital interventions targeting self-regulation or emotion regulation improved weight loss maintenance compared with the active control. A small subgroup effect in men should be interpreted cautiously and does not change this conclusion. The trial provides evidence on both the limitations and potential of digital behavior change interventions for long-term weight outcomes. Future digital interventions may benefit from enhanced engagement and tailored content to improve long-term weight outcomes.

Recent modernization of food processes and Westernized lifestyles have raised concerns about the increased consumption of Ultra-Processed Foods (UPF). Evid

Background/Objectives: Over the past two decades, the incidence of early-onset colorectal cancer (EoCRC) has been increasing, although its underlying causes remain unclear. Gut microbiome is known to play a role in carcinogenesis of colorectal cancer. This scoping review aims to systematically map and synthetize current evidence on gut microbiome characterization in EoCRC (vs. late-onset colorectal cancer (LoCRC) and healthy individuals), describe the methodology used, and identify knowledge gaps to inform and guide future research. Methods: This systematic scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. Searches were conducted in PubMed, Web of Science, and Scopus between January and February 2025. Two reviewers independently screened and selected the studies. One reviewer extracted the relevant information, using an adapted version of the JBI template. Results: Seven studies met eligibility criteria. Compared to healthy young adults, EoCRC patients had a predominance of lower α diversity, different β diversity, and greater abundance of Flavonifractor plautii, Akkermansia muciniphila, Bacteroides, and Fusobacteria. Comparisons with LoCRC showed that EoCRC had distinct β diversity and a higher abundance in Fusobacterium, Akkermansia, Bacteroides, and Actinomyces. Only three studies correlated the microbiota composition of EoCRC with clinicopathology features and suggested positive associations between Fusobacterium abundance, rectal tumors and lower survival and Akkermansia abundance with body mass index (BMI) ≥ 25 kg/m², rectal EoCRC, and better survival. Conclusions: There is a lack of large, methodologically robust studies linking gut microbiota with clinicopathological, lifestyle, and tumor molecular features in EoCRC. Our review highlights critical knowledge gaps, the need for standardized methodologies, and key areas for future investigation.

Gestational diabetes mellitus (GDM) is a pregnancy complication affecting many women, requiring changes in behaviours, which command them to learn self-care practices shortly. Digital interventions have been developed to support women with GDM. However, they have often overlooked women’s needs and characteristics and failed to frame self-care theories into their design. To address this issue, we adopted a mixed methods approach to develop and refine a user-centred, evidence-based digital Toolkit for supporting self-care in GDM, providing behavioural and educational content, particularly about nutrition. To inform the development and refinement of the Toolkit, we conducted a literature review, observed sixty-six nutrition appointments, interviewed eleven dietitians and seventeen patients, and held co-creation sessions with two dietitians, all of which were analysed using a deductive Thematic Analysis. To validate the Toolkit, we conducted a survey with seventeen healthcare professionals, which was analysed using descriptive statistics. The final version of the NUTRIA Toolkit consists of four main modules with thirty-eight artefacts, including behavioural tools to assist women in GDM management. Despite some limitations, this study robustly endorsed the development and refinement of a user-centred, evidence-based Toolkit for supporting self-care in GDM, aiming for future feasibility and trial testing.

Objective: Physical activity and nutrition-related behaviors are crucial factors in maintaining weight loss. The interplay between the motivations to consistently engage in both behaviors is a fundamental yet understudied topic. The current study examines the reciprocal effects between exercise and eating motivation and their effect on steps and energy intake over a 12-month period. Methods: Data were gathered from 678 NoHoW participants (a weight loss management intervention) in 3 European countries (the United Kingdom, Denmark, and Portugal), with baseline, 6-, and 12-month measures (46 ± 11 years, 70% women, 83 ± 15 kg), assessing exercise motivation, eating motivation, steps taken, and energy intake. The analytical plan included latent growth models and cross-lagged panels. Results: Both autonomous and controlled motivation models indicated a positive spillover effect from exercise to eating motivation and vice versa for 12 months. Increased exercise autonomous motivation was linked to heightened eating autonomous motivation, and the same relation was observed with controlled motivation. However, when it came to the relationship between motivation and steps taken or food intake, the effects were either smaller or nonexistent, except for higher initial levels of exercise-controlled motivation being associated with higher food intake after 6 months. Conclusions: These findings suggest that during the yearlong study, there was a motivational spillover from exercise motivation to eating motivation and vice versa. This suggests that interventions focusing on increasing motivation toward behavior change in one domain also benefit other domains and thus might help increase the effectiveness of interventions.

O objetivo deste estudo foi analisar a associação entre a motivação e vários aspectos da prática de exercício físico (EF) em indivíduos que mantiveram a perda de massa corporal, e explorar o papel do gênero. A amostra foi constituída por 253 participantes, foram avaliadas as suas características sociodemográficas, a composição corporal, o EF, a motivação geral e específica para o exercício, com instrumentos validados. Utilizou-se o teste t-de student para comparar as diversas variáveis entre os participantes. Para analisar a associação entre as variáveis motivacionais e os diferentes aspectos do EF, utilizou-se o coeficiente de correlação de Pearson. Foram ainda criados tercis para as variáveis motivacionais e posteriormente comparadas as médias dos vários aspectos do EF, através do teste da ANOVA one-way. Observaram-se diferenças entre gêneros no que respeita à intensidade, duração e dispêndio energético e na maioria das variáveis motivacionais, favorecendo o gênero masculino. Identificaram-se associações positivas entre as variáveis motivacionais relacionadas com o EF, nomeadamente a motivação intrínseca e as regulações de ordem mais autônoma, e os diferentes aspectos do EF, na amostra total e no gênero feminino (p < 0,05). Em indivíduos com sucesso na manutenção da perda de massa corporal, particularmente nas mulheres, motivações mais autônomas para o EF associaram-se a maior prática de EF. Essas conclusões são significativas para programas de perda de massa corporal e promoção de saúde, indicando que a motivação autônoma pode ser um fator de sucesso na manutenção da massa corporal.

Purpose: Preventing weight regain can only be achieved by sustained changes in energy balance-related behaviors that are associated with weight, such as diet and physical activity. Changes in motivation and self-regulatory skills can support long-term behavioral changes in the context of weight loss maintenance. We propose that experiencing a supportive climate care is associated with enhanced satisfaction of basic psychological needs, intrinsic goals, and autonomous motivation. These factors are expected to be associate with the utilization of self-regulation skills, leading to more sustained behavior changes and ultimately preventing weight regain. This hypothesis was tested in this ancillary analysis of the NoHoW trial, where the study arms were pooled and followed for 12 months. Methods: The NoHoW was a three-center, large-scale weight regain prevention full factorial trial. In this longitudinal study, data were collected in adults who lost > 5% weight in the past year (N = 870, complete data only, 68.7% female, 44.10 ± 11.86 years, 84.47 ± 17.03 kg) during their participation in a 12-month digital behavior change intervention. Weight and validated measures of motivational- and self-regulatory skills-related variables were collected at baseline, six- and 12 months. Change variables were used in Mplus’ path analytical models informed by NoHoW’s logic model. Results: The bivariate correlations confirmed key mediators’ potential effect on weight outcomes in the expected causal direction. The primary analysis showed that a quarter of the variance (r2 = 23.5%) of weight regain prevention was achieved via the mechanisms of action predicted in the logic model. Specifically, our results show that supportive climate care is associated with needs satisfaction and intrinsic goal content leading to better weight regain prevention via improvements in self-regulatory skills and exercise-controlled motivation. The secondary analysis showed that more mechanisms of action are significant in participants who regained or maintained their weight. Conclusions: These results contribute to a better understanding of the mechanisms of action leading to behavior change in weight regain prevention. The most successful participants used only a few intrinsic motivation-related mechanisms of action, suggesting that habits may have been learned. While developing a digital behavior change intervention, researchers and practitioners should consider creating supportive climate care to improve needs satisfaction and intrinsic goal contents. Trial registration: ISRCTN, ISRCTN88405328, registered 12/22/2016.