To review randomized controlled trials (RCTs) published from 2021–2023 that reported the effects of peer support interventions on outcomes in patients with type 2 diabetes (T2DM). Literature searches yielded 137 articles and nine RCTs were ultimately reviewed. The reviewed trials involved in-person support groups, peer coach/mentor support, cultural peer support by community health workers, peer support during shared medical appointments (SMAs) including virtual reality-based SMAs, telehealth-facilitated programs, and telephone peer support. Most interventions combined two or more peer support strategies. Peer support was associated with significant decreases in HbA1c in 6 of the 9 reviewed studies. The largest statistically significant improvements in HbA1c were reported in a study of community health workers in Asia (-2.7

Gauge the effectiveness of self-monitoring of weight for weight loss. Daily self-weight monitoring results in increased weight loss, or improved weight maintenance as compared to infrequent or no self-weight monitoring. Self-weighing is most effective when tied with other behavioral interventions including tracking caloric intake and physical activity tracking. Self-monitoring of weight is an effective behavioral weight loss intervention which allows patients to track their progress, but also allows them to connect daily life activities with their weight, fostering real-time feedback that allows them to make more informed and personalized decisions related to dietary choices, physical activity, and lifestyle medicine.

Objectives: Maintaining lean soft tissue and bone mineral density during early to middle adulthood is important for delaying the effects of sarcopenia and osteopenia later in life. Physical activity high in intensity and volume is associated with optimal bone health. CrossFit® (CF) training combines high-intensity aerobic, resistance, and floor exercises to stimulate physical fitness and health responses. We tested differences in total and regional body composition between adult CF participants and nonactive (NA) adults. Methods: 24 CF trained (at least 3 times/wk for the past 3 months, n=11 women) and 24 NA (exercise no more than 1 time/wk for the past 3 months, n=12 women) adults were measured for body composition by iDXA (Lunar Corporation, Madison, WI). Subjects were further categorized into early (≤29y, mean=24y) and middle (30-49y, mean=37y) adulthood. Results: Linear models testing the main and interactive effects of training group and age group demonstrated no difference (p=0.82) in body weight of CF (77.5kg) and NA (76.6 kg) groups. CF had lower trunk (p< 0.002), android (p=0.001), gynoid (p=0.01), arm (p< 0.003), leg (p< 0.05), and total body (p=0.01) fat mass, lower total body %fat (p=0.002) and greater trunk (p=0.01), arm (p< 0.03), leg (p< 0.02), and total body (p=0.002) lean soft tissue (LST) mass. Younger adults had lower android (p< 0.04) and arm (p< 0.02) fat. CF had greater pelvis (p=0.004), arms (p< 0.01), legs (p< 0.04), spine (p< 0.02), trunk (p< .0009), and total body (p< 0.03) bone mineral density. Conclusions: CF training, typically high in intensity and volume, is associated with beneficial body composition and bone health with few differences between early- and middle-aged adults. CF training maintained through at least middle adulthood may delay the onset of difficulty performing daily activities, falls, and morbidities associated with the effects of sarcopenia and osteopenia. Funding Sources: USDA-Agriculture Research Service.

Abstract Purpose of Review Gauge the effectiveness of self-monitoring of weight for weight loss. Recent Findings Daily self-monitoring of weight results in increased weight loss, or improved weight maintenance as compared to infrequent or no self-monitoring of weight. Self-weighing is most effective when tied with other behavioral interventions including tracking caloric intake and physical activity tracking. Summary Self-monitoring of weight is an effective behavioral weight loss intervention which allows patients to track their progress, but also allows them to connect daily life activities with their weight, fostering real-time feedback that allows them to make more informed and personalized decisions related to dietary choices, physical activity, and lifestyle medicine.

Objectives Identify the incidence, rate of physician recognition, diagnostic practices and cancer outcomes for unintentional weight loss (UWL).Methods We completed a secondary analysis of structured and unstructured EHR data collected from adult patients between January 1, 2020 and December 31, 2021. We used four common definitions to define UWL, excluding patients with known causes of weight loss, intentional weight loss, and pregnancy. Unstructured physicians' notes were used to identify both intentional weight loss (e.g. dieting) as well as physician recognition of UWL. Cancer outcomes were identified within 12 months of UWL using diagnostic codes. Physician actions (lab tests, etc.) in response to UWL were identified through manual chart review.Results Among 29,494 established primary care patients with a minimum of two weight measurements in 2020 and in 2021, we identified 290 patients who met one or more criteria for UWL (1 %). UWL was recognized by physicians in only 60 (21 %). UWL was more common and more likely to be recognized among older patients. Diagnostic practices were quite variable. A complete blood count, complete metabolic profile, and thyroid stimulating hormone level were the three most common tests ordered in response to UWL. Five patients were diagnosed with cancer within 12 months of UWL (3 in whom UWL was recognized; two in whom it was not.)Conclusions Unintentional weight loss is poorly recognized across a diverse range of patients. A lack of research-informed guidance may explain both low rates of recognition and variability in diagnostic practices.

Purpose of Review To describe the social, demographic, and health correlates of fast food (FF) consumption. Recent Findings There does not appear to be a consistent definition or measurement method for FF intake, which may limit attempts to synthesize findings. However, we did analyze results based on these varying measurements and found consistent results. While FF consumption is very common across all respondents, it is more frequent among those who are younger, Black, and male. FF consumption varies by income, with middle-income and wealthier people consuming more. Although increasingly common worldwide, FF consumption appears to vary based upon cultural norms. Immigrants may show FF intake more in line with the norms of their country of origin than their new environment. Employed individuals appear to consume more FF. This is especially true among highly educated women. Job-related factors, such as the type of work and a higher number of hours worked, are associated with higher FF consumption. Longitudinal studies have noted that increased FF intake predicts increased BMI and adiposity, predisposing those to lifestyle-derived illnesses. Summary Young Black men tend to consume the greatest amount of FF, even when they have university degrees and well-paying jobs. Sociodemographic factors, such as gender, education, employment, and race/ethnicity often interact and indicate greater specificity is needed into how FF consumption fits into lived context.

Purpose of Review:A variety of mobile-based applications aimed at weight loss have become popular in recent years. This review describes the features and effectiveness of mobile weight loss apps.Recent Findings:Overall, mobile apps can help patients lose weight either as well as or better than traditional paper-and-pencil weight loss interventions and often better than minimal intervention control groups. Mobile apps promote multiple strategies, including self-monitoring of diet, exercise, and weight, as well as social support and educational content. Significant variation exists in app types, which makes it difficult to conclude which features drive program effectiveness. Intervention success varies based on patients' level of engagement with the app. There is a deficit of apps and app-based studies of older, less tech-savvy adults, ethnic/racial minorities, and low-income individuals, as well as longer-term studies.Summary:Mobile apps can successfully help patients lose weight and represent a cost-effective, accessible alternative to intensive in-person weight loss programs. More research is needed into their long-term potential, especially for hard-to-reach populations.

Purpose Models of appetite control have been largely based on negative feedback from gut and adipose signaling to central appetite centers. However, contemporary models posit that fat-free mass (FFM) or the energy demand of FFM [i.e., resting metabolic rate (RMR)] may play a primary role in the motivational drive for food intake (i.e., food reinforcement). The relative reinforcing value of food (RRV food ) is associated with energy intake (EI) and increases with an acute energy deficit. Chronic exercise-induced energy deficits lead to alterations in fat mass (FM), FFM, and RMR and provide an opportunity to test whether change in (∆) FM, ∆FFM, ∆usual EI, or ∆RMR are associated with ∆RRV food . Methods Participants ( n = 29, BMI = 25–35 kg/m 2 ) engaged in aerobic exercise expending 300 or 600 kcal, 5 days/weeks for 12 weeks. The reinforcing value of food (PMax food ) was measured via a computer-based operant responding task and RRV food was calculated as the reinforcing value of food relative to non-eating sedentary behaviors. RMR was determined by indirect calorimetry and body composition by DXA. Results Post-training FFM correlated with usual post-training EI ( r s = 0.41, p < 0.05), PMax food ( r s = 0.52, p < 0.01), and RMR ( r s = 0.85, p < 0.0001). ∆RMR negatively correlated with ∆PMax food ( r s = − 0.38, p < 0.05) and with ∆RRV food ( r s = − 0.37, p < 0.05). ∆PMax food and ∆RRV food were not associated with ∆FFM ( p = 0.71, p = 0.57, respectively). Conclusions Reductions in RMR with weight loss may increase food reinforcement as means of restoring FFM and RMR to pre-weight loss amounts. Limiting reductions in RMR during weight loss may benefit weight maintenance by restricting increases in food reinforcement after weight loss.

Background: Older adults are a high priority for telemedicine given their elevated COVID-19 risk and need for frequent provider contact to manage chronic illnesses. It seems that many older adults now use smartphones but few studies have examined their overall readiness for telemedicine. Objective: The aim of this study is to survey older primary care patients about their telemedicine preparedness, including internet usage, internet-capable devices, telemedicine experiences and concerns, and perceived barriers. Results were used to inform a telemedicine preparedness training program. Methods: Community-dwelling older adult patients (aged 65-81 years; N=30) with a chronic health condition that could be managed remotely who were present at a family medicine clinic that primarily serves an urban African American population for a prescheduled in-person appointment were asked to complete a brief survey written for this study. Data were collected February-June 2021 at a large, urban, Midwestern hospital. To minimize patient burden, the survey was limited to 10 questions, focused on the most critical topics. Results: Most participants (21/30, 70%) reported having a device that could be used for telemedicine and using the internet. However, about half had only a single connected device, and messaging and video calling were the most commonly used applications. Few used email and none used online shopping or banking. Only 7 patients had had telemedicine appointments. Telemedicine users were younger than nonusers and used more internet functions than nonusers. Only 2 people reported problems with their telemedicine visits (technology and privacy). Nearly all respondents recognized avoiding travel and COVID-19 exposure as telemedicine benefits. The most common concerns were loss of the doctor-patient connection and inability to be examined. Conclusions: Most older adults reported having devices that could be used for telemedicine, but their internet use patterns did not confirm the adequacy of their devices or skills for telemedicine. Doctor-patient conversations could be helpful in addressing telemedicine concerns but device and skill gaps must be addressed as well.

Background Few children meet physical activity recommendations, partly due to the prevalence of screen-based sedentary activities. Active video game (AVG) play produces light to moderate physical activity. Yet, providing children access to AVG does not increase physical activity, possibly because children who play AVG may also tend towards sedentary screen-based activities. How multiple days of AVG play influences children’s choice of other activities is not yet known. Purpose To examine how AVG influences children’s physical activity, sedentary screen-based activities, and other alternative activities. Methods Sedentary children (N = 49) played AVG 3 times/week and sedentary video games (SVG) ad libitum for 6 weeks, followed by 4 weeks of ad libitum play of both AVG and SVG. Participants wore an activity monitor for 7 days and completed a 24-hour activity recall on 4 randomly selected days at baseline, week 6, and week 10. Results AVG play increased during the intervention (p < 0.01). Light activity and SVG play both decreased baseline to 10 weeks (p = 0.006) and 6 to 10 weeks (p = 0.017). Non-SVG sedentary behavior increased from baseline to 10 weeks (p = 0.005) and 6 to 10 weeks (p = 0.007). Changes over time were not observed in physical activity, or recall-measured active play, social activities, other hobbies, television or computer/phone use. Conclusion AVG play did not change children’s objectively-measured physical activity or subjectively measured active play. SVG time was substituted with other sedentary behaviors. AVG did not increase time engaged in SVG or screen-based devices.

Abstract Leitch, BA, Wilson, PB, Ufholz, KE, Roemmich, JN, Orysiak, J, Walch, TJ, Short, SE, and Fitzgerald, JS. Vitamin D awareness and intake in collegiate athletes. J Strength Cond Res 35(10): 2742–2748, 2021—Poor vitamin D status is a risk factor for negative health and performance outcomes in athletes, but little is known about how athletes' awareness and beliefs about vitamin D affect their consumption of vitamin D. This observational study investigated awareness of vitamin D for health and performance among collegiate athletes and evaluated the association of vitamin D awareness with its dietary intake. Fifty-two female and 29 male Division I collegiate athletes completed an online vitamin D awareness and dietary intake questionnaire between November 1, 2015, and January 30, 2016. Median intake of vitamin D was 330 International Units (IU), which is below the recommended daily allowance (RDA) of 600 IU, but was greater in male athletes (693 IU) than female athletes (263 IU, p < 0.01). The RDA for vitamin D was met by 62% of men and 30% of women. Athletes responded that vitamin D “probably” or “definitely” will play a role in their health (88.9%) and athletic performance (71.6%). However, only 23.4 and 28.4% of athletes reported concern for their vitamin D levels or believed that they were at risk for deficiency, respectively. Results showed small-to-moderate, positive correlations (r = 0.28–0.495, p < 0.05) between aspects of vitamin D awareness and vitamin D intake, particularly with supplemental forms of vitamin D. Given the lack of awareness concerning risk of vitamin D deficiency, and the links between aspects of vitamin D awareness and vitamin D intake, nutritional education programs designed to increase vitamin D awareness in athletes may be an effective strategy to reduce deficiency.

Purpose of Review Telemedicine has become popular as an alternative for in-person weight loss treatment during the COVID-19 pandemic. This review focuses on weight loss interventions utilizing real-time telemedicine. Recent Findings Telemedicine interventions are usually run as a weekly counseling and educational session or as a complement to a primarily Web-based intervention. A wide variety of healthcare professionals may provide the intervention. Common content includes portion control, increased physical activity, and relapse prevention. Self-monitoring is associated with intervention success. Modalities considered include online chats, text messages, phone calls, and videoconferences. Videoconferencing may be especially useful in capturing the interpersonal connection associated with in-person care but is understudied compared to other modalities. While many interventions show improvements in weight and weight-related outcomes, small sample sizes limit generalizability. Technology access and digital literacy are both necessary. Summary Telemedicine interventions can successfully help patients with obesity lose weight. Telemedicine interventions provide a safe, remote alternative and may expand treatment access to hard-to-reach populations. Further research is needed on telemedicine weight loss treatments for seniors, men, and ethnic minorities, as well as on the impact of long-term interventions.

Purpose of Review Weight loss has long been known to be associated with multiple chronic conditions, including heart failure, COPD, depression, and cancer. Recent reports have suggested that unintentional weight loss (UWL) could be leveraged as an early marker of malignancy. Most studies use standardized cutoff values of ≥5% weight loss to define UWL; however, this threshold has not been validated in different body weight classifications (underweight, overweight, etc.). The purpose of this review was to describe the association between a patient’s weight category, the severity of UWL prior to cancer diagnosis, cancer stage at diagnosis, and cancer-specific mortality. Recent Findings Obesity has been identified as a risk factor for many malignancies. Current data are conflicting about whether patients with obesity are more or less likely to experience UWL prior to diagnosis of a malignancy. Similarly, data analyzing the association between baseline BMI and cancer stage at diagnosis or cancer-specific mortality are mixed. UWL has been associated with an increased risk of all-cause mortality, independent of baseline BMI. Unfortunately, reliable body weight measurements are infrequently obtained, decreasing the likelihood that UWL would be detected clinically. Summary Weight loss, when unintentional, is a serious condition which requires prompt clinical evaluation. Future studies are needed to objectively quantify UWL among patients with varying baseline BMI.

Background: Insufficient compensation for energy from sugar-sweetened beverages (SSBs) consumed prior to meals may promote greater overall energy intake. If so, ability to compensate for prior energy intake may account for difference in adiposity between adolescents with and without overweight. Studies of fraternal siblings discordant for weight status control for some genetic and shared within-family factors, which allows for testing how putative non-shared factors, such as parental control of feeding, predicts sibling weight differences. Aim: To determine whether same-sex weight-discordant (one with, one without overweight) adolescent siblings differ in ability to compensate for prior energy intake. Methods: Same-sex biological sibling pairs (mean age = 15.4; 95% confidence interval (CI) 15.1, 15.7) ( n = 38 pairs; 21 male pairs) consumed a sugar-sweetened (450 kcal) or a non-nutritive-sweetened (10 kcal) liquid preload of equal volumes on separate days, followed by an ad libitum lunch. Multilevel models examined ability to compensate, dietary restraint, and parental control of child’s feeding. Results: Siblings showed insufficient compensation and overate (with overweight = 44 kcal; without overweight = 32 kcal). Siblings shared little within-family similarity in compensation (intra-class correlation coefficient (ICC) = 0.20). Compensation was predicted by parental restriction and general restriction ( p = 0.02) Differences in siblings’ BMI z-scores were associated with differences in dietary restraint ( p = 0.04) not with differences in compensation. Conclusion: Sibling differences in compensation for energy from sweetened beverages were not associated with differences in their adiposity. Compensation may be determined by a constellation of factors, including age, parental feeding practices, and food characteristics.

BACKGROUND Since the COVID-19 pandemic, telemedicine appointments have replaced many in-person healthcare visits [1 2]. However, older people are less likely to participate in telemedicine, preferring either in-person care or foregoing care altogether [3-6]. With a high prevalence of chronic conditions and vulnerability to COVID-19 morbidity and mortality through exposure to others in health care environments, (1-4), promoting telemedicine use should be a high priority for seniors. Seniors face significant barriers to participation in telemedicine, including lower internet and device access and skills, and visual, auditory, and tactile difficulties with telemedicine. OBJECTIVE Hoping to offer training to increase telemedicine use, we undertook a quality improvement survey to identify barriers to, and facilitators of telemedicine among seniors presenting to an outpatient family medicine teaching clinic which serves predominantly African American, economically disadvantaged adults with chronic illness in Cleveland, Ohio. METHODS Our survey, designated by the IRB as quality improvement, was designed based on a review of the literature, and input from our primary care providers and a digital equity expert (Figure 1). To minimize patient burden, the survey was limited to 10 questions. Because we were interested in technology barriers, data were collected on paper rather than a tablet or computer, with a research assistant available to read the survey questions. Patients presenting with needs that could be accomplished remotely were approached by a research assistant to complete the survey starting February 2021 until we reached the pre-determined sample size (N=30) in June 2021. Patients with known dementia, those who normally resident in a long-term care facility, and those presenting with an acute condition (e.g. fall or COPD exacerbation) were ineligible. Because of the small number of respondents, only univariate and bivariate tabulations were performed, in Excel. RESULTS 83% of respondents said they had devices that could be used for a telemedicine visit and that they went on the internet, but just 23% had had telemedicine visits. Few patients had advanced devices (iPhones, desktops, laptops or tablets); 46% had only a single device that was not IOS based mobile (Table 1). All participants with devices said they used them for “messaging on the internet,” but this was the only function used by 40%. No one used the internet for banking, shopping, and few used internet functions commonly needed for telemedicine (23.3% had email; 30% did video calling) (Table 1). 23.3% of respondents had had a telemedicine appointment. Many reported a loss of connection to their doctor as a concern. Participants who owned a computer or iPhone used their devices for a broader range of tasks, (Table 2 and 3), were aged 65-70 (Table 4), and were more likely to have had a telemedicine visit and to have more favorable views of telemedicine (Table 2). Respondents who had not had a telemedicine appointment endorsed a greater number of telemedicine disadvantages and endorsed less interest in future appointments (Table 2). Respondents who did not own an internet-capable device did not report using any internet functions and none had had a telemedicine appointment (Table 2). CONCLUSIONS This small survey revealed significant gaps in telemedicine readiness among seniors who said they had devices that could be used for telemedicine and that they went online themselves. No patients used key internet functions needed for staying safe during COVID, and few used internet applications that required skills needed for telemedicine. Few patients had devices that are optimal for seniors using telemedicine. Patients with more advanced devices used more internet functions and had more telemedicine experience and more favorable attitudes than others. Our results confirm previous studies [7-9] showing generally lower technological proficiency among older adults and some concerns about participating in telemedicine. However, our study is novel in pointing to subtle dimensions of telemedicine readiness that warrant further study—device capacity and use of internet in ways that build skills needed for telemedicine such as email and video calling. Before training seniors to use telemedicine, it’s important to ensure that they have the devices, basic digital skills and connectivity needed for telemedicine. Larger studies are needed to confirm our results and apply multivariate analysis to understand the relationships among age, device quality, internet skills and telemedicine attitudes. Development of validated scales of telemedicine readiness and telemedicine training to complement in-person care can help health systems offer precision-matched interventions to address barriers, facilitate increased adoption, and generally improve patients’ overall access to primary care and engagement with their primary care provider.

Increasing the reinforcing value of a stimulus occurs after repeated exposures to the reinforcer via neuroadaptations that increase the incentive salience of the stimulus. Exercise is a reinforcer and increasing exercise reinforcement (RRVex) may be dependent on simultaneously increasing tolerance for exercise intensity. Positive outcome expectancy (POE) of participating in an intervention can be an important determinant of treatment efficacy, such as when attempting to increase tolerance for exercise intensity or RRVex. We hypothesized that (1) high-intensity interval training (HIIT) that produces great discomfort would increase tolerance for exercise intensity, (2) adding a positive outcome expectancy (POE) component to HIIT would further increase tolerance for exercise intensity and, (3) increases in tolerance for exercise discomfort would mediate increases in RRVex. A randomized controlled trial with a factorial design included HIIT + POE (n = 33 adults, n = 19 women) and HIIT-only (n = 33, n = 19 women) groups. Both groups participated in HIIT 3 d/wk for 6 wks. HIIT + POE received POE treatment each exercise session. Outcomes were measured at baseline, after 6 weeks of HIIT, and 4 weeks post-HIIT (10 wk). Changes in the RRVex were assessed by a progressive ratio schedule of reinforcement task. Other outcomes were outcome expectations, tolerance for exercise intensity, and behavior regulations of exercise. Outcome expectancy did not change in either group. Tolerance for exercise discomfort increased (P < .001) above baseline by 12% at 6 wk and 13% at 10 wk. Intrinsic, integrated, and identified behavior regulations of exercise were all increased (P < .01) at 6 wk and remained so at 10 wk. However, RRVex was not changed and change in RRVex was not correlated with change in tolerance for exercise intensity. HIIT increases tolerance for exercise intensity and intrinsic, integrated, and identified behavior regulations of exercise. USDA-ARS.

Background: Exercise reinforcement predicts physical activity of children. Repeated exposures of physical activity may increase physical activity reinforcement (incentive sensitization). Active videogame (AVG) play produces light-to-moderate-intensity physical activity. Ideally, AVG play would transition to nonscreen-based active play through incentive sensitization of traditional active play (TAP), providing AVG does not increase sedentary videogame (SVG) reinforcement. Greater autonomy increases motivation toward traditional physical activity, but whether autonomy enhances incentive sensitization has not been studied. Objectives: To determine whether autonomy over AVG play promotes incentive sensitization of TAP or SVG. Methods: Inactive children (ages 8-12; 5th-97th body mass index percentile) were provided with AVG and SVG for 6 weeks and assigned to either a high autonomy (n = 25) or low autonomy (n = 24) group, differentiated by AVG choice and more freedom over amount of play. Both groups played AVG 3 days per week. SVG were played ad libitum. Participants completed an operant responding task to measure the relative reinforcing value (RRV) of AVG versus SVG (RRVAVG vs. SVG) and AVG versus TAP (RRVAVG vs. TAP) at baseline, 6 weeks, and 10 weeks. Results: RRVAVG vs. SVG increased over time (P = 0.056) but did not differ by autonomy or autonomy x time (P = 0.184). RRVAVG vs. TAP decreased over time (P = 0.033) but did not differ by autonomy or autonomy x time (P = 0.73). Conclusion: AVG play does not increase motivation toward SVG and increases motivation to play AVG relative to TAP. Providing higher autonomy did not promote incentive sensitization of play.

Purpose of Review Social support, especially from peers, has been found to contribute to successful weight loss and long-term weight loss maintenance. Peer support groups may represent a particularly effective intervention technique for weight loss. This review focuses upon peer support weight loss interventions with the objective of identifying common elements of successful programs. Recent Findings Peer support interventions often consist of expert-led educational content, supplemented by peer-led activities or discussion. Peer groups may provide support to individuals who have little social support in their normal lives. Interventions are often designed for pre-existing groups, especially high-risk groups such as women from ethnic minorities. Men are underrepresented in weight loss programs and often perceive “dieting” as feminine. However, several peer programs for male sports fans have successfully resulted in weight loss and fostering support for healthy lifestyle among male peers. In addition to professionally created peer support groups, many online weight loss communities are created and moderated by peers. Online communities allow participants to share peer support similar to in-person formats. Summary Many peer support interventions show significant short-term weight loss. Group members frequently report that peer support was critical to their weight loss success. A sense of community among likeminded individuals with similar goals was frequently cited. Online peer support groups are becoming increasingly prevalent, may fulfill similar needs to in-person groups, and have additional advantages in accessibility, and access to a larger peer network, and may facilitate long-term adherence.