Saturday, March 28, 2020

Using Teleconferencing to Deliver the Diabetes Prevention Program

For health related programs that require intensive intervention, the intervention can be costly because there are many barriers to delivering the programs. One of these health-related programs is the CDC's National Diabetes Prevention Program or NDPP. It can be difficult for program participants to attend enough in-person sessions to meet their weight loss and other goals. Teleconferencing, which can be used for telehealth, can eliminate many of the barriers hindering attendance at in-person sessions. One study, called SHINE for “Support, Health Information, Nutrition and Exercise,” has shown that teleconferencing can be effective in delivering a version of the CDC’s NDPP for weight loss. It should be noted that in this article, teleconferencing is performed via the telephone.

The NDPP program is a year-long program, consisting of a set of 16 weekly core sessions during the first six months, and a set of core maintenance sessions during the last six months. The NDPP is based on the Diabetes Prevention Program (DPP) study carried out between 1996 and 2001.  In the above mentioned SHINE study, the sessions lasted two years rather than one year. The 16 session curriculum, taken from the original CDC DPP study, was used during the first year of the SHINE study, and a modified version of the curriculum was used for the second year of the SHINE sessions.

Unlike the original DPP study, where the primary outcome was type 2 diabetes, the primary outcome of the SHINE study was weight loss.  For the study, the participants were randomized to two groups – an individual call (IC) group, and a conference call (CC) group. Individuals in the IC-groups received individual telephone calls from a counselor, and individuals in the CC-group received calls from the counselor in a teleconference.

After randomization of subjects to one of the two groups, the IC-group consisted of 129 participants and the CC-group consisted of 128 participants. Measurements, including weight, were taken at baseline, six months, 12 months and 24 months. And the average weight loss for CC-group  was more at the 6, 12 and 24 month assessments than  the average weight loss for the IC-group.  At 6 months, the CC-group average weight loss was 4.0 %  compared to 3.9% for the IC group. At 12 months, the CC-group average weight loss was 4.5% compared to 4.2% for the IC-group. And at the two year period, the CC-group average weight loss was 5.6% compared to 1.8% for the IC-group.

So using teleconferencing is a viable option for weight loss. And a version of the CDC's DPP program curriculum, including the NDPP, can be used to deliver the weight loss program. Those wanting to deliver a version of the DPP should consider using teleconferencing to deliver the program to improve attendance and weight loss.

Thursday, March 19, 2020

A Low-Carbohydrate Diet in Conjunction with Alternate Day Fasting May be Feasible

Intermittent fasting, an eating pattern technique where an individual follows a zero calorie or very low-calorie diet on some days of the week, and follows a regular eating pattern on the other days, is a recognized method for weight loss and glycemic improvement. Low carbohydrate diets are also recognized as a way to lose weight and improve glycemic control. And one study has combined intermittent fasting, in the form of alternate day fasting, with low carbohydrate diets to improve weight and other metabolic processes.

The study combined ADF with a low carbohydrate diet. Ninety-four subjects with obesity (BMIs pf 30 to 49.9) in the Chicago area were selected for the study. Thirty-one subjects completed the study. For the ADF design of the diet, participants ate 600 calories during the fasting days, consisting of 30% carbohydrates, 35% protean, and 35% fat. For the low-calorie design of the diet, participants chose their food ad libitum during the “feast” days, to form a diet, again, consisting of 30% carbohydrates, 35% protean, and 35% fat.

The weight loss study lasted six months, with the first three months being a weight loss period. And the last three months being a weight maintenance period. Meal replacements were used to enable the study participants to take in the desired macronutrient content during the six month study period, while adhering to the 600 calorie limit during the fast days.

At the six month period average weight loss was 6.3%, total cholesterol was reduced by 6% and the LDL was decreased by 8%. There was a decrease in systolic blood pressure by 7 mmHg, and there was a decrease in fasting insulin of 8%.

The investigators concluded that while more research is required, the “findings suggest that ADF combined with the low carbohydrate diet is effective for weight loss, weight maintenance, and improving certain metabolic disease risk factors such as LDL-cholesterol, blood pressure, and fasting insulin.” The study shows that ADF plus low carbohydrate diet is an eating pattern that probably should be given some consideration by healthcare providers.

Subscribe to Overfat Strategy Blog by Email