Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts.
Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
J Acad Nutr Diet. 2023 Jul;123(7):1033-1043.e1. doi: 10.1016/j.jand.2023.02.018. Epub 2023 Mar 5.
Understanding the effect lifestyle intervention (LI) has on important psychological and behavioral variables that are associated with weight loss can help inform LI design, content, and delivery.
The aim was to determine the modifiable psychological and behavioral factors that are associated with percent weight loss (%WL) and their relative importance in predicting %WL at 12, 24, and 36 months in the REAL HEALTH-Diabetes randomized controlled trial LI.
This is a secondary analysis of LI arms of the REAL HEALTH-Diabetes randomized controlled trial LI cohort over a 24-month intervention period and 12-month follow-up period. Patient-reported outcomes were measured using validated questionnaires that were either self-administered or administered by a research coordinator.
PARTICIPANTS/SETTING: Adults with type 2 diabetes and overweight/obesity (N = 142) from community health centers, primary care, and local endocrinology practices affiliated with Massachusetts General Hospital in Boston, MA, between 2015 and 2020, were randomized to LI and were included in the analysis.
The LI was a lower intensity adaptation of Look Action for Health in Diabetes's (HEALTH) evidence-based LI delivered either in-person or via telephone. Registered dietitians delivered 19 group sessions during the first 6 months followed by 18 monthly sessions.
The association of psychological (diabetes-related distress, depression, autonomous motivation, diet and exercise self-efficacy, and social support for healthy behaviors) and behavioral (fat-related diet and dietary self-regulation) variables with %WL.
Baseline and 6-month change scores in psychological and behavioral variables were modeled as predictors of %WL at 12, 24, and 36 months using linear regression. Random forests were used to compare the relative importance of changes in the variables in predicting %WL.
Six-month improvement in autonomous motivation, exercise self-efficacy, diet self-efficacy, and dietary self-regulation were associated with %WL at 12 and 24 months, but not at 36 months. Improvement in fat-related diet behavior and depressive symptoms were the only variables associated with %WL at all three timepoints. Autonomous motivation, dietary self-regulation, and low-fat diet behaviors were the three most important predictors of %WL during the 2-year LI.
The REAL HEALTH-Diabetes randomized controlled trial LI resulted in 6-month improvements in modifiable psychological and behavioral factors that were associated with %WL. LI programs for weight loss should focus on skills and strategies to promote autonomous motivation, flexible dietary self-regulation, and habituation of low-fat eating habits during the intervention period.
了解生活方式干预（LI）对与体重减轻相关的重要心理和行为变量的影响，可以帮助确定 LI 的设计、内容和交付方式。
本研究旨在确定与百分比体重减轻（%WL）相关的可改变的心理和行为因素，并确定它们在 REAL HEALTH-Diabetes 随机对照试验 LI 的 12、24 和 36 个月时预测%WL 的相对重要性。
这是 REAL HEALTH-Diabetes 随机对照试验 LI 队列的 LI 臂的二次分析，干预期为 24 个月，随访期为 12 个月。使用经过验证的问卷测量患者报告的结果，这些问卷可以由患者自行填写，也可以由研究协调员填写。
参与者/设置：2015 年至 2020 年期间，来自马萨诸塞州波士顿市社区健康中心、初级保健和当地内分泌学实践的患有 2 型糖尿病和超重/肥胖的成年人（N=142）被随机分配到 LI，并被纳入分析。
LI 是 LOOK Action for Health in Diabetes（HEALTH）循证 LI 的较低强度改编，通过面对面或电话提供。注册营养师在最初的 6 个月内提供 19 次小组会议，然后每月提供 18 次会议。
与 %WL 相关的心理（糖尿病相关困扰、抑郁、自主动机、饮食和运动自我效能以及健康行为的社会支持）和行为（与脂肪相关的饮食和饮食自我调节）变量的关联。
使用线性回归将心理和行为变量的基线和 6 个月变化分数建模为 12、24 和 36 个月时 %WL 的预测因子。随机森林用于比较变量变化在预测 %WL 中的相对重要性。
自主动机、运动自我效能、饮食自我效能和饮食自我调节的 6 个月改善与 12 和 24 个月时的%WL 相关，但与 36 个月时无关。与脂肪相关的饮食行为和抑郁症状的改善是与所有三个时间点的%WL 相关的唯一变量。自主动机、饮食自我调节和低脂肪饮食行为是 LI 期间预测%WL 的三个最重要的预测因子。
REAL HEALTH-Diabetes 随机对照试验 LI 导致可改变的心理和行为因素在 6 个月内得到改善，这些因素与%WL 相关。体重减轻的 LI 计划应侧重于在干预期间促进自主动机、灵活的饮食自我调节和低脂肪饮食习惯的技能和策略。
