Background:In a proof-of-concept trial, a phenotype tailored lifestyle intervention (PLI) led to greater weight loss than a standardized lifestyle intervention (SLI). This secondary analysis evaluated the effect of the PLI for individuals with an emotional eating phenotype (EE) on weight loss outcomes, eating behaviors and mood. Methods:This original clinical research article is a secondary analysis of a 12-week, non-randomized, date-of-treatment trial in which adults with obesity underwent phenotyping and were assigned sequentially to either a PLI (N = 84) or a SLI (N = 81). The EE phenotype was defined as a HADS-A (Hospital Anxiety and Depression Scale for Anxiety) score ≥7. Weight loss outcome and changes in eating behaviors and mood were evaluated among participants with EE assigned to an SLI (n = 19) or a PLI (n = 26). Results:Participants with EE assigned to the PLI achieved greater weight loss at 12-weeks compared with those assigned to the SLI (-5.9% ± 4.4 vs. -2.6% ± 4.8; p = 0.02). Participants with EE assigned to the PLI demonstrated reduced HADS-A and HADS-D scores, and the Three-Factor Eating Questionnaire Emotional Eating subscale (TFEQ-EE), while those assigned to the SLI had minimal or no improvements after 12-weeks. Among participants with EE assigned to the PLI, Higher HADS-A scores and lower scores in the Weight Efficacy Lifestyle questionnaire (WEL) negative emotions subscale and TFEQ-EE at baseline were associated with greater weight loss at 12-weeks. (NCT04073394). Conclusion:These findings support tailoring behavioral weight-loss interventions for adults with obesity and EE. Larger randomized studies with longer follow-up are needed to further refine phenotype-based approaches.

Purpose Survivors of critical illness often acquire significant physical, cognitive, and psychological burdens following their intensive care unit (ICU) stay, termed "post-intensive care syndrome" (PICS). Screening for PICS is generally not performed outside of research settings largely due to lack of a simple assessment tool and time constraints.Methods This was a prospective cohort study at a single academic medical center in the USA. We included adults (18 years or older) who spent greater than 48 h in any ICU within the medical center. Following transfer out of the ICU and at 3 months, psychological, cognitive, and physical functioning were assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, Montreal Cognitive Assessment-blind, and Barthel Index. We compared these validated questionnaires to a brief, 15-item PICS screening tool (5 questions/domain) that was developed by our multidisciplinary study team and administered to study participants after ICU discharge to general care. The primary objectives of this study were to assess the ability of validated screening tools administered at ICU discharge to predict PICS at 3 months and develop a novel screening tool for identifying patients at risk of PICS.Major Findings 191 participants completed the initial questionnaire, and 109 (56%) completed the 3-month follow-up. PICS tool scores were compared to 3-month follow-up data from validated questionnaires to evaluate predictive performance. Overall, the screening tool weakly-to-moderately correlated with continuous outcomes of the validated measures at 3-month follow-up. When evaluating sensitivity and specificity for individual domains, the screening tool had an area under curve of >0.7 for all three domains, indicating moderate-to-good sensitivity and specificity.Conclusions We developed a brief PICS screening tool that is feasible to use without prior training that modestly predicted the development of PICS following ICU stay.

Social disconnection, both in the form of social isolation and loneliness, is increasingly recognized as a clinically significant but underappreciated risk factor for cardiovascular disease (CVD), affecting 16-25% of individuals. Population studies have consistently linked social disconnection to a higher risk of all-cause mortality, myocardial infarction, stroke, and cardiovascular death, yet routine screening for social disconnection is uncommon in everyday clinical practice. Even when identified, due to both lack of strong evidence-based interventions and awareness about them, meaningful clinical changes are seldom observed. In light of growing recognition by major health authorities, including the World Health Organization and the U.S. Surgeon General, and of the Harvard Study of Adult Development, showing that social integration and strong relationships are the most powerful predictors of healthy aging, we conducted a narrative literature review synthesizing current evidence on the relationship between social disconnection and CVD. The mechanism mediating social disconnection and cardiovascular events is still a matter of debate. We focus on cortisol-oxytocin imbalance and highlight that it is central in causing CVD through autonomic dysregulation, nutritional imbalance and gut microbiome alterations. Alongside psychosocial comorbidities, these factors may converge on endothelial dysfunction as an initiating mechanism of CVD. Our review also aims to foster discussion on how to recognize and address social disconnection in clinical practice, emphasizing the need for structured, multidisciplinary pathways as well as trials assessing their effect on improving both social disconnection and the associated CVD risk.

Background Immigrants to the United States often face challenges from limited healthcare access and less healthy environments which contribute to rising obesity and cardiovascular risk. Purpose To assess the feasibility and effectiveness of a community-based social network intervention for cardiovascular risk reduction among Hispanic and Somali adults. Methods A social network-informed, community-based participatory research-derived health promotion intervention was delivered by Hispanic and Somali lay health promoters (HPs) to members of their social networks over 1 year (12 biweekly sessions in months 0-6; 12 biweekly check-ins in months 7-12). Using a closed-cohort stepped wedge cluster randomized design, social networks were randomly assigned to receive the intervention immediately or after a delay of 1 year. Measurements at baseline, 6 months, and 12 months were derived from 6 of the American Heart Association's "Life's Simple 7": BMI, blood pressure, fasting glucose, cholesterol, physical activity and dietary quality (range 0-12, with higher values indicating lower cardiovascular risk). Waist circumference and proportion of participants who achieved >5% body weight loss were also assessed. Results Four hundred seventy-five participants were enrolled among 51 HPs (29 Hispanic; 22 Somali). There was a statistically significant improvement in cardiovascular risk in the intervention group (n = 246) compared with controls (n = 229) at 6 months (0.4 [1.8] vs. -0.1 [1.7]; P = .03) that was not sustained at 12 months (0.5 [1.9] vs. 0.3 [1.8]; P = .38). There was a statistically significant higher proportion of participants who lost >5% of body weight in the intervention group compared with controls at 12 months (37% [15] vs. 18% [7.9]; P = .02). Reductions in weight and waist circumference in the intervention group compared with controls did not achieve statistical significance. Conclusion A social network intervention, delivered by lay HPs was feasible and resulted in a modest improvement of cardiovascular risk and clinically significant weight loss.Clinical Trial Identification Number NCT05136339.

Home-based pulmonary rehabilitation (HBPR) with health coaching (HC) in people with chronic obstructive pulmonary disease (COPD) has been reported to produce behavior change by improving accelerometry-measured physical activity level and quality of life (QoL). However, a theoretical framework supporting the observed behavior change has not been tested in people with COPD. Therefore, the purpose of this secondary analysis was to examine the mechanism by which HBPR with HC improved physical and emotional QoL, by testing a theoretical framework that may support the positive effect of the intervention. The hypothesis was that the Self-Determination Theory (SDT) supports the behavior change observed after the 12-week HBPR with HC in patients with moderate to very severe COPD. This theory posits that by supporting the individual’s experience of autonomy, competence, and relatedness can foster the most volitional and high-quality forms of motivation and engagement for a behavior change. Structural Equation Models (Path Analysis) tested the underlying assumption that competence, autonomy, and relatedness were the factors associated with improvement in the physical and emotional QoL post-intervention. The path models supported the effect HBPR with HC on physical and emotional QoL through a direct effect on competence and relatedness (P <.01) and an indirect effect through autonomy via competence and relatedness. The effect of HBPR with HC in patients with COPD is mechanistically supported by SDT. Addressing competence, relatedness, and autonomy during the pulmonary rehabilitation process may impact physical and emotional QoL, which is of utmost importance to these patients.

Self-efficacy theory proposes that confidence to engage in a health behavior is associated with engaging in that specific behavior. Most research examining self-efficacy has been conducted with white young adult populations. This cross-sectional analysis examined the association of self-efficacy (i.e., confidence) for healthy eating and physical activity in two immigrant communities. At enrollment into the Healthy Immigrant Community study, a clinical weight management and cardiovascular risk reduction intervention set in southeastern Minnesota, 475 participants completed assessments about their confidence for healthy eating and physical activity. Measurements also included self-reports of dietary quality and intake, physical activity, quality of life, and biometric assessments. Study materials were available in English, Spanish, and Somali. In total, 450 adults (Hispanic/Latinx = 267; Somali = 183) completed measures at baseline and were included for analysis. Their average age was 45 years (range 18–87) and 59

Social Media use among individuals pre- and post- metabolic and bariatric surgery (MBS) has dramatically increased in recent years, yet the benefits and risks to patients remain unclear. This systematic review sought to synthesize the literature on social media use among individuals pre-and post-MBS. Objectives were to: 1) explore the patterns of social media use in this population, 2) identify the benefits and risks of MBS-focused social media use and, 3) inform clinicians and patients about strategies to more effectively engage with MBS-focused social media. This systematic review was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analysis and was registered with PROSPERO (CRD42023473191). Studies which included a retrospective or prospective examination of social media and MBS were included. A comprehensive search was performed and published scientific articles were examined by three independent reviewers, resulting in 24 full text articles meeting inclusion criteria based on pre-specified selection criteria. Results are reported by social media platform including Facebook, YouTube, Online Forums/Websites, X (formerly “Twitter”), Instagram, and TikTok. Findings indicate that social media use among individuals pre-and post-MBS is high and Facebook is the preferred platform. Several benefits of social media use were identified including easier access to large peer support communities, inspiration and encouragement, and health information. Possible downsides to social media use include problems with the accuracy of MBS content on social media. Given these findings, MBS clinicians can use this information to inform their patients about strategies to promote benefits and reduce potential risks of social media use.

Obesity is a chronic complex disease with deleterious effects on multiple organs and systems through a process called lipotoxicity. Obesity is commonly associated with a range of systemic comorbidities, including cardiovascular diseases, obstructive sleep apnea, type 2 diabetes mellitus, dyslipidemia, osteoarthritis, and depression. Unfortunately, these conditions can be overlooked in the clinical setting, yet early detection and intervention of obesity-related comorbidities can lead to significantly improved health outcomes and well-being. An important consideration for clinicians is that obesity is the root cause and its associated comorbidities are downstream conditions. This perspective may help prioritize the management of obesity in the clinical setting. Adopting this clinical approach to treating obesity may help to improve or resolve several related conditions simultaneously rather than treating each condition as an isolated unassociated disease. This comprehensive review is based on the published literature on PubMed and Google Scholar and summarizes the latest recommendations and guidelines from international associations when diagnosing multimorbidity associated with adiposity and can be a valuable resource for diagnosing and managing obesity in the primary care setting.

PURPOSE:Home-based pulmonary rehabilitation (HBPR) with health coaching (HC) in people with chronic obstructive pulmonary disease (COPD) has been reported to produce behavior change by improving accelerometry-measured physical activity level and quality of life (QoL). However, a theoretical framework supporting the observed behavior change has not been tested in people with COPD. Therefore, the purpose of this secondary analysis was to examine the mechanism by which HBPR with HC improved physical and emotional QoL, by testing a theoretical framework that may support the positive effect of the intervention. The hypothesis was that the Self-Determination Theory (SDT) supports the behavior change observed after the 12-week HBPR with HC in patients with moderate to very severe COPD. This theory posits that by supporting the individual's experience of autonomy, competence, and relatedness can foster the most volitional and high-quality forms of motivation and engagement for a behavior change. METHODS:Structural Equation Models (Path Analysis) tested the underlying assumption that competence, autonomy, and relatedness were the factors associated with improvement in the physical and emotional QoL post-intervention. RESULTS:The path models supported the effect HBPR with HC on physical and emotional QoL through a direct effect on competence and relatedness ( P <.01) and an indirect effect through autonomy via competence and relatedness. CONCLUSIONS:The effect of HBPR with HC in patients with COPD is mechanistically supported by SDT. Addressing competence, relatedness, and autonomy during the pulmonary rehabilitation process may impact physical and emotional QoL, which is of utmost importance to these patients.

Patients with advanced cancer and their caregivers experience a substantial amount of anxiety and distress. The purpose of this study was to assess the feasibility, acceptability, and preliminary effects of an 8-week, remotely delivered Resilient Living Program (RLP) for adult patients with advanced cancer and their caregivers. Eligible patients included adults (≥18 years) with advanced cancer. Their caregiver had the option to participate. The RLP components included online modules, a print journal, and 4 video-telehealth-delivered sessions. Content focused on techniques for managing stress and building resilience (mindful presence, uplifting emotions, reframing experiences through practicing principles of gratitude, compassion, acceptance, meaning, and forgiveness). Feasibility and acceptability were assessed quantitatively and with semi-structured interviews conducted with a subset of participants. Effectiveness measures (anxiety, stress, quality of life [QOL], sleep, resiliency, and fatigue) were administered at baseline, week 5, week 9, and week 12. Of the eligible patients, 33/72 (46%) were enrolled. In all, 15 caregivers enrolled. Thirty participants (21 patients/9 caregivers) completed at least 3 video-telehealth sessions (63% adherence). For patients, there were statistically significant improvements in anxiety and fatigue at week 12 (p = 0.05). Other effectiveness measures (stress, QOL, sleep, resiliency) showed positive trends. Eleven participants were interviewed and qualitative analysis revealed 4 themes: Easy to Use, Learning Key Principles, Practice is Essential, and Examples of Benefits. Participation in the RLP was feasible and acceptable for patients with advanced cancer and their caregivers. Participants tended to indicate that the practices were easy to integrate into their everyday lives, engendered their ability to focus on the positive, and would recommend the RLP to other individuals living with advanced cancer. Preliminary effectiveness data suggest the program may positively impact anxiety, stress, QOL, sleep, resiliency, and fatigue. A larger randomized clinical trial is warranted to confirm these preliminary findings.

OBJECTIVE:Major Depressive Disorder (MDD) is characterized by high stress sensitivity and unsatisfactory response rates to standard treatments. Stress and depression share a bidirectional relationship. We, therefore, conducted a pilot randomized control trial (RCT) to understand if adjunctive stress management and resiliency training tailored for depression(SMART-D), can improve treatment outcomes in patients with MDD, receiving treatment as usual(TAU) with standard treatments (medications and/or psychotherapy), in real-world clinical settings, compared to a group receiving TAU. METHODS:Participants with MDD, in a current depressive episode, were randomized to adjunctive SMART-D (delivered by video telehealth over 8 weeks), compared to TAU alone. Random assignment, blinding of raters and statistician were utilized. The primary outcome measure was baseline to end point change in depression [Hamilton Rating Scale for Depression (HAM-D] over a 6-month follow-up period using a mixed model regression analysis. RESULTS:27 participants (mean age 47.9 ± 14 years, female 67%) enrolled in the study (TAU = 14, SMART-D + TAU = 13). Baseline mood ratings were in mild-moderate symptom severity (HAM-D)- SMART-D + TAU = 12.2 ± 6.6, TAU = 13.9 ± 5.7). Linear mixed model analysis showed significant Group*Time interaction for measures of depression (HAM-D) (B = 6.1 (CI = 1.5-10.8, P = .01) and perceived stress (PSS) (B = 5.5(0.5-10.6), p = .03) between the 2 groups at 3 months post follow-up ((HAMD)-SMART-D + TAU = 8.7 ± 4.3 Vs. TAU = 16.1 ± 6.3), but not at 6-months (SMART-D + TAU = 8.1 ± 5.4 Vs. TAU = 12.3 ± 5.5). CONCLUSIONS:A RCT of 27 adults with MDD provide initial support that an adjunctive resiliency intervention (SMART-D) for patients with MDD may positively impact symptoms of depression and perceived stress, earlier than standard care. A small sample size limits ability to draw firm conclusions. Further investigation is warranted, using larger samples. Clinical Trials Registration I.D.# NCT04388748.

Objective: Examine the impact of a participatory wellness continuing medical education (CME) program on physician burnout, wellness, and well-being. Methods: Physicians attending a 3-day wellness CME program. Self-reported questionnaires at baseline with paired analyses at 26-week follow-up. Results: Compared to baseline, at 26 weeks there were decreases in burnout (P < 0.001, ES -0.68), red meat consumption (P = 0.02, ES -0.29), and current stress levels (P < 0.001, ES -0.50). There were increases in fruit/vegetable consumption (P < 0.001, ES 0.55), energy levels at work (P < 0.001, ES 0.60) and at home (P < 0.001, ES 0.66), quality of life (P < 0.001, ES 0.53), and confidence (P < 0.001, ES 0.89) and frequency (P = 0.01, ES 0.32) of counseling patients on wellness. Conclusion: Attendance at this participatory wellness CME program was associated with improved physician burnout, health behaviors in diet, stress, energy, quality of life, and wellness counseling.

Background: Immigrants to the United States face structural barriers that contribute to rising cardiovascular risk factors and obesity after immigration. This manuscript describes the development of the Healthy Immigrant Community protocol and baseline measures for a stepped wedge cluster randomized trial to test the effectiveness of a social network intervention for cardiovascular risk reduction among two immigrant populations. Methods: We developed a social network-informed, community-based, participatory research-derived health promotion intervention with Hispanic and Somali immigrant communities in Minnesota consisting of mentoring, educational and motivational sessions, group activities, and a community toolkit for healthy weight loss delivered by culturally concordant health promoters (HPs) to their social networks. Using a stepped wedge cluster randomized design, social network-based groups were randomly assigned to receive the intervention either immediately or after a delay of one year. Outcomes, measured at baseline, 6 months, 12 months, and 24 months, were derived from the American Heart Association's "Life's Simple 7": BMI and waist circumference, blood pressure, fasting blood glucose, total cholesterol, physical activity level, and dietary quality. Results: A total of 51 HPs were enrolled and randomized (29 Hispanic; 22 Somali). There were 475 participants enrolled in the study, representing a mean social network group size of 8 (range, 5-12). The mean BMI of the sample (32.2) was in the "obese" range. Conclusion: Processes and products from this Healthy Immigrant Community protocol are relevant to other communities seeking to reduce cardiovascular risk factors and negative health behaviors among immigrant populations by leveraging the influence of their social networks.