Publications by authors named "Brooke T Nezami"

9 Publications

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Predictors and Outcomes of Digital Weighing and Activity Tracking Lapses Among Young Adults During Weight Gain Prevention.

Obesity (Silver Spring) 2021 04;29(4):698-705

Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Objectives: Self-monitoring is critical for weight management, but little is known about lapses in the use of digital self-monitoring. The objectives of this study were to examine whether lapses in self-weighing and wearing activity trackers are associated with weight and activity outcomes and to identify objective predictors of lapses.

Methods: Participants (N = 160, BMI = 25.5 ± 3.3 kg/m , 33.1 ± 4.6 years old) were drawn from a sample of young adults in the Study of Novel Approaches to Prevention-Extension (SNAP-E) weight gain prevention trial. Analyses evaluated associations between weighing and tracker lapses and changes in weight and steps/day during the first 90 days after receiving a smart scale and activity tracker.

Results: On average, participants self-weighed 49.6% of days and wore activity trackers 75.2% of days. Every 1-day increase in a weighing lapse was associated with a 0.06-lb gain. Lapses in tracker wear were not associated with changes in steps/day or weight between wear days. Weight gain predicted a higher likelihood of starting a lapse in weighing and tracker wear, whereas lower steps predicted a higher likelihood of a tracker lapse.

Conclusions: Weight gain may discourage adherence to self-monitoring. Future research could examine just-in-time supports to anticipate and reduce the frequency or length of self-monitoring lapses.
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http://dx.doi.org/10.1002/oby.23123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995618PMC
April 2021

Promoting physical activity in young adult cancer survivors using mHealth and adaptive tailored feedback strategies: Design of the Improving Physical Activity after Cancer Treatment (IMPACT) randomized controlled trial.

Contemp Clin Trials 2021 04 27;103:106293. Epub 2021 Jan 27.

Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Introduction: Despite the health benefits of physical activity for cancer survivors, nearly 60% of young adult cancer survivors (YACS) are physically inactive. Few physical activity interventions have been designed specifically for YACS.

Purpose: To describe the rationale and design of the IMPACT (IMproving Physical Activity after Cancer Treatment) trial, which tests the efficacy of a theory-based, mobile physical activity intervention for YACS.

Methods: A total of 280 physically inactive YACS (diagnosed at ages 18-39) will be randomized to a self-help control or intervention condition. All participants will receive an activity tracker and companion mobile app, cellular-enabled scale, individual videochat session, and access to a Facebook group. Intervention participants will also receive a 6-month mobile intervention based on social cognitive theory, which targets improvements in behavioral capability, self-regulation, self-efficacy, and social support, and incorporates self-regulation strategies and behavior change techniques. The program includes: behavioral lessons; adaptive goal-setting in response to individuals' changing activity patterns; tailored feedback based on objective data and self-report measures; tailored text messages; and Facebook prompts encouraging peer support. Assessments occur at baseline, 3, 6, and 12 months. The primary outcome is total physical activity min/week at 6 months (assessed via accelerometry); secondary outcomes include total physical activity at 12 months, sedentary behavior, weight, and psychosocial measures.

Conclusions: IMPACT uniquely focuses on physical activity in YACS using an automated tailored mHealth program. Study findings could result in a high-reach, physical activity intervention for YACS that has potential to be adopted on a larger scale and reduce cancer-related morbidity. ClinicalTrials.gov Identifier: NCT03569605.
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http://dx.doi.org/10.1016/j.cct.2021.106293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089056PMC
April 2021

Examination of a partial dietary self-monitoring approach for behavioral weight management.

Obes Sci Pract 2020 Aug 26;6(4):353-364. Epub 2020 Apr 26.

WW New York NY USA.

Introduction: Dietary self-monitoring in behavioral weight loss programmes traditionally involves keeping track of all foods and beverages to achieve a calorie deficit. While effective, adherence declines over time. WW™ (formerly Weight Watchers), a widely available commercial weight management programme, sought to pilot an approach that permitted participants to consume over 200 foods without monitoring them.

Methods: The current study used a pre-post evaluation design with anthropometric, psychosocial and physical health assessments at baseline, 3 and 6 months.

Results: Participants ( = 152) were, on average, 48.4 (±12.3) years old, with body mass index (BMI) of 32.8 (±4.8) m/kg and 94% female. Mean weight loss was 6.97 + 5.55 kg or 7.9 ± 6.1% of initial body weight (s < .0001) at 6 months. One third (32.6%) of the sample lost 10% or more of initial body weight. Significant improvements in hunger, cravings, happiness, sleep, quality of life, aerobic stamina, flexibility and blood pressure were observed. Attendance at group meetings, as well as decreases in hunger, and fast food cravings from baseline to 3 months were associated with achieving 10% weight loss at 6 months ( < .01).

Conclusions: Using an approach that does not require self-monitoring of all foods and beverages produced significant weight losses and other physical and psychosocial improvements.
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http://dx.doi.org/10.1002/osp4.416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448156PMC
August 2020

Perceived Benefits and Barriers in the Mediation of Exercise Differences in Older Black Women with and Without Obesity.

J Racial Ethn Health Disparities 2020 08 12;7(4):807-815. Epub 2020 Jun 12.

Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14214, USA.

Objectives: Weight control is an exercise benefit, important for older Black women, a group experiencing obesity disparities. We compared perceived exercise benefits and barriers between Black women with and without obesity and determined which mediated the weight group-exercise relationship.

Methods: A survey (n = 234) was administered to determine attitudinal agreement between weight groups (obese or non-obese). Multiple mediation analysis was used to investigate if attitudes mediated the weight group-exercise relationship.

Results: High agreement with all exercise benefits was observed between women with and without obesity. Compared with women without obesity, women with obesity were more likely to report the barriers of only exercising to lose weight (OR = 2.52, 95% CI 1.40-4.55), lack of will power (OR = 1.82, 95% CI 1.05-3.19), weight (OR = 3.04, 95% CI 1.34-6.83), and cost (OR = 2.14, 95% CI 1.02-4.47). Exercising to lose weight and lack of will power mediated the weight group-exercise relationship.

Conclusions: Women largely agreed on the exercise benefits. Lack of will power and engaging in exercise only for weight loss were barriers that were more common among older Black women with obesity. The barriers partially explained the lower exercise engagement in women with obesity. Future work may address these barriers to increase exercise in older Black women.
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http://dx.doi.org/10.1007/s40615-020-00788-6DOI Listing
August 2020

Examining barriers, physical activity, and weight change among parents and nonparents in a weight loss intervention.

Obes Sci Pract 2020 Jun 30;6(3):264-271. Epub 2020 Jan 30.

Departments of Health Behavior and Nutrition University of North Carolina at Chapel Hill North Carolina.

Introduction: Little is known about the influence of children in the home on physical activity and weight among adults in weight loss interventions. This study evaluated the association between number of children in the home, weight loss, and weight regain in a behavioural weight loss intervention, and whether those relationships were mediated in sequence by physical activity barriers and physical activity changes.

Methods: The sample included 267 participants from a randomized trial who had complete data on study variables. Variables at baseline, 6, and 18 months included physical activity barriers, objectively measured minutes of moderate-to-vigorous physical activity (MVPA), and objectively measured weight used to calculate percent weight loss (PWL) from baseline to 6 months and percent weight regained (PWG) from 6 to 18 months.

Results: A greater number of children in the home was associated with less PWL at 6 months. This relationship was mediated by greater baseline physical activity barriers and a smaller increase in MVPA at 6 months. The mediated effect was no longer significant when controlling for changes in dietary intake. There was no relationship between number of children and PWG from 6 to 18 months.

Conclusions: Parents may need unique intervention supports to overcome barriers to initiation of physical activity to help them reach optimal weight loss.
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http://dx.doi.org/10.1002/osp4.401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278899PMC
June 2020

Randomized trial comparing group size of periodic in-person sessions in a remotely delivered weight loss intervention.

Int J Behav Nutr Phys Act 2017 10 23;14(1):144. Epub 2017 Oct 23.

Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7294, USA.

Background: Few randomized studies have examined differential effects of group size in behavioral weight control, especially in hybrid programs that include Internet treatment approaches.

Methods: Randomized controlled trial (n = 195) comparing a 4 month hybrid internet weight loss program coupled with monthly face to face groups of 100 persons (Large Group, LG; 1 group) or to the same approach with monthly groups of 20 persons (Small Group, SG; 4 groups). Repeated-measures mixed-model analysis with age and race as covariates were used to estimate primary (weight) and secondary outcomes, and to test group differences in change over time.

Results: The sample was 46.3 years old ±10.4, 90.3% female, and 51.9% non-white, with BMI 37.9 ± 8.4 kg/m. Participants in the LG were more likely to return for the 4-month assessment visit than those in the SG (p = 0.04). Participants randomized to both the LG and SG conditions experienced significant WL over time (no between group difference: -4.1 kg and -3.7 kg, respectively) and weight loss was positively associated with attendance at monthly meetings and logins to the website. Satisfaction with the program was high and similar in both groups (94.4% reported that they were "satisfied" or "very satisfied").

Conclusions: Using a hybrid approach of in-person and online weight loss interventions may be an effective way to reach larger and more diverse populations. Delivering the face to face component of the intervention in groups larger than those traditionally delivered (20-25 people) could increase the cost-effectiveness of group-based behavioral weight loss interventions.

Clinical Trials Registration Number: NCT01615471 . Registered June 6, 2012. Registered retrospectively.
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http://dx.doi.org/10.1186/s12966-017-0599-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654056PMC
October 2017

The influence of fathers on children's physical activity: A review of the literature from 2009 to 2015.

Prev Med 2017 Sep 24;102:12-19. Epub 2017 Jun 24.

Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Parents are influential in promoting children's physical activity. Yet, most research has focused on how mothers influence children's activity, while little empirical attention has been devoted to understanding how fathers may influence children's activity. The purpose of this review was to summarize observational studies from 2009 to 2015 examining the influence of fathers on children's physical activity. A publicly available database, from a prior systematic review, containing information on 667 studies of parenting and childhood obesity from 2009 to 2015 was searched for potential studies. Studies were eligible if: 1) fathers were included as participants, 2) results were presented for fathers separate from mothers, 3) fathers' physical activity or physical activity parenting was assessed, and 4) child physical activity was measured. Ten studies met eligibility criteria. All studies were rated as fair quality. The majority of studies (n=8) assessed the relationship between father and child physical activity. Of 27 associations tested, 14 (52%) were significant, indicating a modest, positive relationship between father and child activity. Of the studies examining fathers' physical activity parenting (n=3), there were three significant associations out of 15 tested (20%) and no consistency among measured constructs. No differences were observed in the influence of mothers vs. fathers on children's physical activity. Limited evidence was available to examine moderating effects of child sex or age. Few studies have examined the effect of fathers on child physical activity and this relationship remains unclear. Future studies should target fathers for research and investigate specific pathways through which fathers can influence child activity.
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http://dx.doi.org/10.1016/j.ypmed.2017.06.027DOI Listing
September 2017

A randomized trial to reduce sugar-sweetened beverage and juice intake in preschool-aged children: description of the Smart Moms intervention trial.

BMC Public Health 2016 08 19;16(1):837. Epub 2016 Aug 19.

Department of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box #7440, Chapel Hill, NC, 27599, USA.

Background: Obesity in young children remains a public health concern, and maternal weight is one of the strongest predictors of obesity in early childhood. However, parental adherence in interventions for young children is often low and existing programs have had mixed success. An innovative approach to treatment is needed that increases adherence among mothers and improves weight-related behaviors simultaneously in mothers and children. The objective of the Smart Moms randomized controlled trial (RCT) is to test the efficacy of a 6-month primarily smartphone-delivered program to reduce sugar-sweetened beverage and juice consumption among children ages 3-5 whose mothers are overweight or obese. This paper describes the study design and intervention.

Methods/design: Mother-child dyads were eligible if the mother was overweight or obese, owned a smartphone, and if the child was between the ages of 3-5 and consumed 12 oz or more per day of sugar-sweetened beverages (SSBs) and 100 % fruit juice. Participants were randomly assigned to the Smart Moms intervention or a waitlist control group. The intervention consisted of theoretically grounded and evidence-based behavioral strategies delivered through one group session, lessons on a mobile-optimized website, and text messages. Mothers submitted self-monitoring information via text message and received regular tailored feedback emails from interventionists. The primary outcome is change in child SSB and juice consumption and a secondary outcome is change in maternal weight.

Discussion: This Smart Moms study was designed to determine if a low-burden intervention delivered using mobile methods and targeted towards mothers could be effective at changing child sugar-sweetened beverage intake. Results will indicate if mobile-based methods can be a feasible way to engage mothers in family-based studies and will inform successful strategies to prevent childhood obesity through parent-targeted approaches.

Trial Registration: Clinicaltrials.gov NCT02098902 (Registered March 25, 2014).
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http://dx.doi.org/10.1186/s12889-016-3533-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992273PMC
August 2016

The Effect of Self-Efficacy on Behavior and Weight in a Behavioral Weight-Loss Intervention.

Health Psychol 2016 May 16. Epub 2016 May 16.

Objective: To determine whether eating self-efficacy (ESE) and physical activity self-efficacy (PASE) are predictive of dietary intake, physical activity, and weight change within a behavioral weight-loss intervention, and whether dietary intake and physical activity mediate relationships between self-efficacy and weight change.

Method: The study sample included 246 participants from a randomized trial with complete data on study variables at 12 months. ESE, PASE, calories consumed, minutes of moderate-to-vigorous physical activity (MVPA), and weight were measured at baseline, 6, and 12 months.

Results: ESE at baseline was associated with 12-month percent weight loss (PWL), and was mediated by average calories consumed at 6 and 12 months. Change in ESE from baseline to 6 months was associated with calories consumed at 12 months and 12-month percent weight loss, but the mediated relationship was not significant. Baseline PASE was not associated with average MVPA at 6 and 12 months or 12-month PWL, but change in PASE from baseline to 6 months was associated with 12-month PWL through its effect on MVPA at 12 months.

Conclusion: Increases in ESE and PASE during the active phase of the intervention are predictive of dietary intake, physical activity and weight loss at later points, but further research should include explorations of the reciprocal relationship between behavior and self-efficacy to better inform intervention strategies that target self-efficacy and promote behavior change. (PsycINFO Database Record
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http://dx.doi.org/10.1037/hea0000378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112140PMC
May 2016
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