Evaluation of a Telenutrition Weight Loss Intervention Among Middle-Aged and Older Men in Appalachia

Abstract

Obesity rates among middle-aged and older men in WV are among the highest in the nation. Understanding baseline and intervention factors contributing to losing clinically significant weight are essential to developing effective interventions in target groups. Thus, the purpose of this study is to determine factors associated with losing ≥ 5% of baseline weight among participants of a 12-week pilot randomized controlled telenutrition trial for middle-aged and older men in WV. The study analyzed data from 56 participants who completed the trial. Participants were classified as losing ≥ 5 % or < 5 % of baseline body weight. Diet quality was assessed using 4-day diet records and the Healthy Eating Index (HEI)-2015. Baseline factors and behavioral strategies (i.e., self-monitoring, self-efficacy, and social support) were assessed via survey. Inverse prediction analysis demonstrated that participants who lost ≥ 3.5% of baseline weight at 6 weeks were at least 75% likely to lose ≥ 5% weight at 12 weeks. Predictive models were developed using stepwise logistic regression to assess multiple predictors of losing ≥ 5% of baseline weight at 12 weeks and ≥ 3.5% of baseline at 6 weeks. Weight loss at 6 weeks was a strong predictor of weight loss at 12 weeks, in addition to previous weight loss attempts and weekly self-weight-monitoring (p<0.05). Specifically, a greater probability of losing ≥ 5% of baseline weight at 12 weeks was estimated for participants who: always self- monitored weekly weight (odds ratio (OR) 34), did not attempt other weight loss programs in the past (OR 64), and had lost weight at 6 weeks (OR 5 for one percent increase in weight loss at 6 weeks). Analysis of factors leading to the ≥ 3.5% baseline weight loss at 6 weeks detected that increasing HEI change score at 6 weeks (OR 1.1 for each one-unit increase of HEI), and report of a family starting to eat better (OR 5) were influential. These findings suggest that for middle-aged men with obesity, early weight loss is important to losing ≥ 5% of baseline weight at the end of the intervention. The results support the use of behavioral strategies such as increased self-monitoring of weekly weight and focusing on healthier eating for the whole family, as these factors were related to better weight loss outcomes at the end of the intervention. Participants should be encouraged to self-monitor their weekly weights and dietary intake and be provided strategies to help them adhere to a high-quality diet in future interventions.