Health and Medicine
Today, more and more attention is being paid to the health state nationwide. Obesity influences physical activity and causes a variety of heart diseases that are also known as cardiovascular diseases (CVD). This disease has an impact on heart and blood vessels. One of the reasons why cardiovascular diseases appear is the lack of activity in a person’s life. However, the majority of scientists persist that individual lifestyle is the number one determinant, if we speak about the nascency of the CVD. In the article “Processes of Behavior Change and Weight Loss in a Theory-Based Weight Loss Intervention Program: A Test of the Process Model for Lifestyle Behavior Change,” the authors surmise that minor intervention into the lifestyle might show very promising results in the behavior change that causes improvement in clinical aspects.
Keywords: weight loss, healthy lifestyle, intervention, behavior, cardiovascular disease
Health and Medicine
It was argued that intervention of the behavior is restricted by our own ability to improve personal lifestyle in modern conditions. Nevertheless, the authors claim that if behavior mechanism might be changed, this might allow building the basis for behavior change of the lifestyle and intervention strategy elaboration. The created links are related to the theoretical mediators that are specific and tightly connected to the behavior change. As hypothesized, the change of theoretical mediators is influenced by a specific technique. After some observations, the scientists have tested it on the result of a change in behavior outcome. This approach allows assuming that by means of specific mechanisms, it is possible to influence the overall lifestyle behavior.
Accordingly, the main stress in the current paper was made on the fact that change in behavior is not the final result. It is rather the process, where the main attention is paid to the effects that appear intermediate during the behavior change process. However, authors emphasize that, in fact, the minor changes in the behavior patterns are the cornerstone of the long-term improvements that might be achieved through deeper analysis of behavior mediators to improve lifestyle and reduce the level of cardiovascular diseases, where an intervention is a method, but not the tool.
Methods and Materials
In order to prove the hypothesis, the scientists run the trial that was fully controlled and randomized. The name of the trial was Waste the Waist, the adopted version of the Greater Green Triangle Diabetes Prevention Project (Gillison et al., 2015). For this, authors have applied the special intervention mapping that allowed to systematize the whole process. During the project, special emphasis was made on the behavior change process. Though, beforehand, the scientists have conducted the assessment, to receive the full picture of the participants’ behavioral patterns and their state of health. On the basis of behavior determinants, they analyzed the behavioral patterns and the possible changes that might be implemented during the pilot project. For each participant afterward, they prepared the specification of what needs to be changed in the behavior. The specification was done regarding the specific need, for example, the weight loss. As the main aim of the Waste the Waist trial was to understand whether interventions are able to influence positively on the weight loss, they were included in the map strategy.
The first and main point of the pilot project were to reduce the weight. Participants were suggested to reduce the intake of fat and increase the consumption of fiber and physical activity. These theoretically in basis interventions were applied through mapping among the cardiovascular group, which was done under the risk from the UK. The scientists choose Process Model for Lifestyle Behavior Change (PMLBC) model as the starting point from the theoretical perspective. This model points out the main processes that influence the results of the change in the lifestyle behavior via the increment of the self-governing risk and expectations, which are closely related. Additionally, they promoted the creation of the rigorous plan of action, which included overcoming the possible barriers and the ability to gain support from the society. For the participants, the so-called circles of self-regulation were organized, where they used the reflection and the feedback as a tool. Additionally, each participant of the pilot project within the group was involved in self-monitoring. Such approaches allowed handling the review and updates of the present results and correlate them with goals.
The project was divided into the few stages, according to PMLBC. The core session lasts for four months, while the maintenance session continued up to eight months. All framework took about the year to cover and implement the philosophy of the study. During the core session, the scientists emphasized an understanding of the behavior processes by the participants. They also motivated them, developed the confidence and provided the social support. The resulting effect of such actions supposes to help the participants to engage into action, increase self-monitoring, develop problem awareness and problem-solving. In four month, being aware of self-confidence and understanding that they are efficient in weight loss participants and having the social support, moved to the next session. In the maintenance session, all activities, taken in the core session phase, became the part of the participants. Thereafter, in a time period of twelve-month, the main change in participants lifestyle was outlined in the confidence that they might be efficient independently.
All changes described above were worked out and polished during nine half-structured meetings of the group, that suppose to provide social support during the next nine months. The participants shared knowledge and skills with each other that improved understanding of the process and helped to overcome the obstacles that they faced during the adoption period and the project maintenance phase. With the help of interventions, changes were applied in diet and physical activities. Effect of those changes appeared step by step. However, the basic transformation was observed in the phycological perception. Afterward followed the change of the phycological perception of the lifestyle behavior.
The phycological perception change was observed by the coaches within the group. Change behavior was analyzed and represented in the lifestyle through group interaction. As the scientists claim in the paper, they believed that such workflow allowed predicting changes and monitoring them, according to the pilot project aims. Moreover, participants, themselves, help a lot, when they controlled fat consumption and fiber intake. As a result, the authors claim that at some point of the study they were able to predict the improvement based on the result of the enhancement in the lifestyle behavior. Changes were observed in the fourth and twelfth months of the study.
The involved participants in the study aged 40 till 74 with BMI (body mass index) 28 Kg/m2 – 45 Kg/m2 (Gillison et al., 2015), who were in the cardiovascular disease zone risk. The scientists excluded from the trial project those participants who already had heart diseases and diabetes of 2nd type, pregnant, people who were not able to communicate in English or were taking pills for weight loss.
In the beginning, the authors of the article used 13 techniques in a group session that last two hours (Gillison et al., 2015). In each session, there were involved 8 – 12 participants, usually working with coaches. Such intervention helps to build social support and form the ability for self-reflection and create an atmosphere for constructive feedback. The aim of such session was to shape the understanding of idea what healthy lifestyle is, and how small changes might become the basis for fascinating results. For control, participants used provided handbooks with all needed references and information. Every week they took away tasks that were completed and created the action plan for the next week. On this path, the help to the group was provided by six professional coaches and professional doctors, who measured biometric indexes baseline data. The protocol of the study and research was published in the International Controlled Trials Register and other related research platforms.
After the project analysis, the results of 108 participants aged 46 – 75 with M = 62.5 and SD 7.0 were the following. Out of 108 participants, 33% were women. Only 4% have finished the school at age 16, while 25% have graduated from the university. The waist measurement showed that women reached mark 103.2 cm, and men managed to get 113.1. SD (standard deviation) by women and men was 8.9 and 8.5 accordingly. In the family history, only 20% of participant mentioned diabetes and 58% claimed that the family medical history has heart diseases.
The results of the study were sum up in the table for comparison of four and twelve-month measurements. As a result, in control group, weight changes after baseline measurement were lower, comparing them to the intervention group results. For example, in the fourth month, the control group weight was 96.65 kg (the initial weight 97.57 kg), while in the intervention group, the result after four-month was 93.78 with initial weight 96.63 kg. The difference after calculations was – 0.67 kg. While taking into consideration the comparison of fat intake, the difference was – 0.21 (27.57 and 24.22 for control and intake group accordingly). According to these numbers, one might create the impression that physical activity played a significant role in weight change. However, the difference between two groups was -.09 of activity count. On the opposite, fiber intake positively influenced the overall weight loss. A number of fiber intake was β = – 0.3 and for fat it was β = 0.3. The participant rarely enjoyed fiber intake as a result for it is – 0.1. The most significant weight difference was 3.7 kg with 95% CI: 2.0 to 5.5, p < 0.001 in the fourth month and 4.1 kg, 95% CI: 1.2 to 7.1, p < 0.01 in twelve months (Gillison et al., 2015). These results were achieved based on self-motivation, engagement into the group work, self-monitoring, and reflection.
For the study, the scientists have chosen people aged 40 – 76 with heart disease. It has to be mentioned that this topic is relevant not only for adults but also for teenagers and youth. Overweight is becoming an issue in the modern world. The way of life and technologies are influencing more and more on the understanding what healthy lifestyle is. It would be great to conduct this research among office workers, who usually spent their day in front of the computer and rarely pay attention to what they eat and how they feel. Moreover, during such project, it is important to consider figure, as there are mesomorphs, for example, whose metabolism differs from endomorphs. Accordingly, they will have different diet and list of physical activities. Nevertheless, this topic might be used in the community to promote a healthy lifestyle among youngsters, teenagers, and youth via workshops and sports activities that help to form healthy lifestyle behavior.
For the scientists, the main aim was to bring the positive change in the lifestyle behavior via a change in the diet as well as understanding and acceptance by the participants the idea of weight loss with the help of small steps using interaction. The authors of the article agree that the strategy of physical activities requires changes so it was possible to promote it. As for intervention, the measurement showed that results are long lasting and might show the significant result if one keeps track of fat and fiber intake. The model needs minor enhancement, so it could be tested on a larger amount of participants. It was mentioned that it might be modified into a model of a full-scale intervention project. Overall, the research has provided the support of the hypothesis that intervention might be the cornerstone in the lifestyle behavior change.