Impact of the built, social, and food environment on long‐term weight loss within a behavioral weight loss intervention

Abstract

Background Behavioral weight loss interventions can lead to an average weight loss of 5%–10% of initial body weight, however there is wide individual variability in treatment response. Although built, social, and community food environments can have potential direct and indirect influences on body weight (through their influence on physical activity and energy intake), these environmental factors are rarely considered as predictors of variation in weight loss. Objective Evaluate the association between built, social, and community food environments and changes in weight, moderate‐to‐vigorous physical activity (MVPA), and dietary intake among adults who completed an 18‐month behavioral weight loss intervention. Methods Participants included 93 adults (mean ± SD; 41.5 ± 8.3 years, 34.4 ± 4.2 kg/m2, 82% female, 75% white). Environmental variables included urbanicity, walkability, crime, Neighborhood Deprivation Index (includes 13 social economic status factors), and density of convenience stores, grocery stores, and limited‐service restaurants at the tract level. Linear regressions examined associations between environment and changes in body weight, waist circumference (WC), MVPA (SenseWear device), and dietary intake (3‐day diet records) from baseline to 18 months. Results Grocery store density was inversely associated with change in weight (β = −0.95; p = 0.02; R2 = 0.062) and WC (β = −1.23; p < 0.01; R2 = 0.109). Participants living in tracts with lower walkability demonstrated lower baseline MVPA and greater increases in MVPA versus participants with higher walkability (interaction p = 0.03). Participants living in tracts with the most deprivation demonstrated greater increases in average daily steps (β = 2048.27; p = 0.02; R2 = 0.039) versus participants with the least deprivation. Limited‐service restaurant density was associated with change in % protein intake (β = 0.39; p = 0.046; R2 = 0.051). Conclusion Environmental factors accounted for some of the variability (<11%) in response to a behavioral weight loss intervention. Grocery store density was positively associated with weight loss at 18 months. Additional studies and/or pooled analyses, encompassing greater environmental variation, are required to further evaluate whether environment contributes to weight loss variability.

GLP-1 Receptor Agonists and Related Mental Health Issues; Insights from a Range of Social Media Platforms Using a Mixed-Methods Approach

“…Managing type 2 diabetes, including taking medicines, maintaining a healthy lifestyle, and monitoring blood glucose levels can be stressful, and this can be a factor in the development of depression and thoughts of suicide. Furthermore, the combination of type 2 diabetes and depression may be particularly evident in deprived socio-economic groups, possibly due to food insecurity issues [1,[86][87][88][89]. Based on the content of current posts, these inequalities were possibly behind those posts reporting difficulties in both getting a prescription and communicating with physicians, which, in turn, may be due to healthcare access and health insurance issues.…”

New insights in the mechanisms of weight‐loss maintenance: Summary from a Pennington symposium

“…Conversely, limited evidence suggests there is an increased consumption of fresh fruit and vegetables when access is increased [75]. Not only is the built environment related to obesity risk and physical activity, but data support that environmental factors, including grocery store density, walkability, and economic status of a neighborhood, explains up to 11% of the variability in response to a weight-loss intervention [79]. It is likely that such factors are also involved in the success of WLM.…”

Assessing Acceptability: The Role of Understanding Participant, Neighborhood, and Community Contextual Factors in Designing a Community-Tailored Cooking Intervention

“…Cooking intervention studies including African Americans have reported improvement in self-reported dietary quality, but the overall inclusion of African Americans within clinical nutrition interventions remains a key gap area for addressing diet-related disease disparities [11]. Community-tailored cooking interventions may be required for the necessary inclusion of African Americans within intervention studies as African Americans represent racially categorized individuals who disproportionately live within racialized communities that serve as impediments to dietary quality as a result of adverse environmental and social factors [12][13][14][15].…”