Rena R. Wing

Background: Cancer survivors face long-term health challenges posttreatment. Physical activity (PA) can help manage cancer-related side effects and offer additional health benefits, yet up to 80% of survivors do not meet PA guidelines. Effective and translatable PA interventions are needed. Objective: This randomized trial assessed the feasibility, acceptability, and preliminary efficacy of a 12-week automated Internet program for increasing moderate-to-vigorous physical activity (MVPA) among cancer survivors. A secondary aim examined the effect of the intervention on physical and mental well-being. Methods: Inactive (P<.001). Energize! increased self-reported (92.7 min/wk), bouted (35.4 min/wk), and total (46.3 min/wk) MVPA at 3 months (Cohen d=0.74‐0.94), and these changes were partially maintained at 6 months. Increases in MVPA were smaller among Newsletter participants (d=0.28‐0.47). Group differences in health-related outcomes were minimal and mixed, favoring Energize! over Newsletter for vitality (d=0.63) and somatization (d=0.76) at 3 months, and for depression (d=0.59) and anxiety (d=0.51) at 6 months. Conclusions: The automated Energize! Program is feasible, acceptable, and associated with positive changes in MVPA, yet future studies are needed to improve MVPA long-term. Findings suggest that self-guided PA programs may be beneficial for increasing MVPA among cancer survivors.

Screening for obesity and eating disorders (EDs) offers a pathway to treatment. The current study surveyed U.S. college healthcare providers regarding screening for obesity and EDs. Providers (n = 1,159) from a nationally-representative sample of 384 college health centers. Providers completed surveys regarding obesity and ED screening practices and beliefs. Provider-level and organizational-level factors were examined as predictors of screening frequency. Providers reported screening larger percentages of female students for obesity (70%) than EDs (30%) and were more likely to report a center-wide policy to screen for obesity (59.1%) than EDs (33.9%). Providers reporting a routine screening policy predicted screening frequency in both obesity and EDs. Most providers believed screening for obesity (75.6%) and EDs (82.5%) was a good idea. Obesity is screened for more often than EDs in college health centers. Understanding screening barriers will be beneficial in connecting students with obesity and/or EDs to care.

Self-monitoring technology (e.g., smartphone applications) aids weight loss, but its role in weight maintenance remains under studied. To evaluate use and perceptions of self-monitoring technologies in National Weight Control Registry (NWCR) participants (adults who have maintained a ≥30lbs loss for ≥1 year) who maintained versus regained weight. NWCR participants completed an online survey about self-monitoring technology use and perceptions. Of 1,000 invited participants, 794 completed the survey. Those who reported gaining ≥2.3kg (5lbs) in the past year were categorized as the "regain" group (40.8%); those reporting p<.01) and diet (p<.01) but not exercise (p=.23) than "maintain". There were no differences in wearable trackers interest, most valued features, or use barriers, but the "regain" group was more likely to report guilt, discouragement, body image concerns, and anxiety about weight loss when using behavior-tracking technologies (p<.001); rates of discontinuation from these feelings or unhealthy weight control practices were not different between groups. This appears to be the first study investigating naturalistic use of self-monitoring technology in a demographically homogenous sample maintaining significant weight loss. The "regain" group was more likely to use self-monitoring technology but reported more tracking-associated negative feelings. Future research must determine how to support individuals emotionally and with weight maintenance when self-monitoring contributes to negative byproducts. Other work should identify the optimal elements of self-monitoring technology for weight loss maintenance.

Lower cardiorespiratory fitness and obesity may accelerate aging processes. The degree to which changes in fitness and body mass index (BMI) may alter the rate of aging may be important for promoting lifestyle changes. We assessed cross-sectional and longitudinal associations that cardiorespiratory fitness and BMI had with a deficit accumulation frailty index (FI). Fitness (based on standardized graded exercise tests) and weight (to calculate BMI) were collected at baseline and year 4 from 3,944 participants, ages 45-76 years, in the Action for Health in Diabetes (Look AHEAD) randomized controlled clinical trial. A validated 38-item FI was used as a marker of aging. Associations between baseline levels and changes in fitness and BMI with changes in FI were assessed using linear models. Both baseline and 4-year changes in fitness and BMI were independently associated with 4-year changes in frailty (all p< 0.001). Participants with the greatest fitness increase and BMI loss tended to have improvements (i.e., decreases) in FI: mean [95% confidence interval] changes -0.019 [-0.024,-0.013]. Those with the greatest fitness loss and increases in BMI tended to have worsening (increased) FI: 0.029 [0.024,0.034]. Associations of 4-year changes in fitness and BMI with FI changes were similar across subgroups based on age, gender, baseline BMI, diabetes duration, and cardiovascular disease history. Increased fitness across 4 years was associated with less FI accumulation independent of baseline fitness. Adults with type 2 diabetes and overweight or obesity may slow aging processes by increasing their cardiorespiratory fitness and losing weight.

Objective: Cardiovascular health (CVH) declines in young adulthood. This study assessed whether weight gain prevention interventions promoted ideal CVH.Methods: Young adults (n = 599; age 18–35 years; BMI: 21.0–30.9 kg/m²) from a randomized controlled trial comparing two weight gain prevention interventions (self‐regulation with large or small changes) and a self‐guided control group completed anthropometric and clinical assessments at baseline and 2 years. CVH was quantified via the American Heart Association's Life's Simple 7 (LS7) number of ideal components met.Results: Both interventions showed significant improvements in the average number of ideal LS7 components met at 2 years compared with control (pre‐ to post‐treatment means; large change: 0.24, small change: 0.34, control: −0.2, p < 0.05). Moreover, a greater percentage of participants in both interventions improved by ≥1 ideal component (large change: 35%, small change: 37%, control: 29%) and a smaller percentage declined by ≥1 ideal component (large change: 16%, small change: 20%, control: 30%) compared with control. For individual LS7 components, the odds of having an ideal BMI and glucose varied by treatment condition at 2 years.Conclusions: Two weight gain prevention interventions led to improvements in ideal CVH at 2 years. Interventions explicitly focused on a broader constellation of LS7 domains might lead to even greater changes in CVH.

Objectives: The primary objective was to examine associations between mothers' television and mobile device (TV/MD) use and responsive feeding during an observed mother-toddler mealtime interaction. The secondary objective was to assess whether dimensions of child temperament were associated with mothers' TV/MD use. Methods: Participants from a prenatal lifestyle intervention trial to prevent excess gestational weight gain among women with overweight and obesity (N = 77) were observed during a dinner-time meal when their children were aged 19.4 ± 0.9 months. Trained video coders used the Responsiveness to Child Feeding Cues Scale to rate child strength of early/subtle, positive active, and negative active satiation cues and maternal responsiveness to these cues. Coders also recorded mothers' use of TV/MD. Child temperament was reported by mothers through the Infant Behavior Questionnaire–Revised Very Short Form. Results: Twelve percent (n = 9) of mothers used TV/MD during the mealtime interaction. Children whose mothers used TV/MD exhibited stronger early/subtle cues (4.1 ± 0.4) compared with children whose mothers did not use TV/MD (3.4 ± 0.2; p = 0.04). Mothers who used TV/MD exhibited significantly lower responsiveness to child satiation cues (2.0 ± 0.4) than those who did not use TV/MD (3.4 ± 0.2; p = 0.001). Greater child temperamental negative affectivity was associated with a greater likelihood of maternal TV/MD use (OR = 4.80, 95% CI = 1.21, 19.03). Conclusion: Mothers' TV/MD use was associated with greater child temperamental negative affectivity and lower responsiveness to child cues.

Objective: The aims of this study were as follows: 1) examine weight changes in older adults (mean age = 76 years) with type 2 diabetes and overweight or obesity during the COVID‐19 shutdown; and 2) compare the behavioral and psychosocial effects of the shutdown in those who had large weight losses (>5%), those who had small weight losses (2%‐5%), those who remained weight stable (±2%), or those who gained weight (>2%).Methods: Look AHEAD (Action for Health in Diabetes) participants (N = 2544) were surveyed during the COVID‐19 shutdown (2020), and they self‐reported their current weight, reasons for weight change, weight‐related behaviors, psychosocial measures, and negative and positive effects of the pandemic on their lives.Results: Comparing self‐reported weight during the COVID‐19 shutdown with earlier measured weight, Look AHEAD participants lost, on average, 2.2 kg during the COVID‐19 shutdown: 47% lost >2%, and only 18% gained >2% (p < 0.0001). Decreases in physical activity and increases in screen time were reported frequently in all weight‐change categories. Similarly, there were few differences among the categories on standardized psychosocial measures or self‐reported effects of the shutdown on participants' lives. However, when differences were seen, the most negative impact was in those who gained weight.Conclusions: Although weight loss appeared more common than weight gain during the shutdown, the weight‐change groups did not differ on most psychosocial and behavioral variables.

Lifestyle interventions are the first-line therapy for weight loss, based on multiple randomized clinical trials demonstrating efficacy. However, whether these approaches can be successfully translated to community or clinical settings remains unclear. For example, the Diabetes Prevention Program (DPP) was a highly successful efficacy trial, in which patients randomized to a lifestyle intervention attained a 7% weight loss at 1 year and reduced risk of diabetes, compared with the control group, by 58% (4.8% vs 11.0% risk of diabetes), but efforts to translate this to community settings have had mixed results.¹

Little is known about week-to-week recovery from regains following a behavioral weight loss intervention (BWLI). This study examined changes in behaviors, cognitions, and moods associated with transitioning from weight regain to weight loss during the nine-month weight loss maintenance period after a three-month Internet-based BWLI. Participants (n = 68) self-weighed daily via "smart" scales and answered 40 weekly questionnaires about their weight-related behaviors and psychological states. Mixed models were used to (a) determine whether weight gain in a given week predicted changes in weight, behaviors (e.g., self-monitoring), and psychological states (e.g., mood, temptation) the following week and to (b) compare back-to-back weeks when individuals recovered from weight gain (gained in the first week and lost in the second) versus those in which they gained both weeks. Weight gain in a given week predicted greater weight gain and greater report of behaviors and psychological states associated with weight gain the following week. Back-to-back weeks when individuals switched from gaining to losing were few (5%) compared with weeks when individuals continued gaining (60%). Switching from gaining to losing was associated with greater physical activity during the initial weight gain week and greater self-reported behaviors/cognitions consistent with weight loss (e.g., greater calorie self-monitoring, greater importance of "staying on track") during the following week. Engagement in more weight loss consistent behaviors and more favorable ratings of key psychological variables were associated with the rare shifts from gaining to losing. Future research should investigate interventions to help individuals quickly recover from weight regain. (PsycInfo Database Record (c) 2022 APA, all rights reserved).