A two-year, technology-based intervention to prevent weight gain among young adults in community college effectively reduced consumption of fast food and improved overall weight-related behavioral patterns. The intervention was less effective in changing specific behaviors, including physical activity and sleep.
[Photo: Dr. Leslie Lytle]
These findings and more are the results of the Choosing Healthy Options in College Environments and Settings (CHOICES) study – the first large-scale, randomized controlled trial to evaluate a weight gain prevention program targeted at young adults attending two-year community colleges. This population is at heightened risk for developing obesity and is seldom studied.
Dr. Leslie Lytle, professor and chair of health behavior and professor of nutrition at the UNC Gillings School of Global Public Health, was principal investigator for the study and is co-author of a paper about the findings titled, “Results of a 2-year randomized, controlled obesity prevention trial: Effects on diet, activity and sleep behaviors in an at-risk young adult population.” The paper was published online June 7 by Preventive Medicine.
In the study, Dr. Lytle and colleagues addressed the fact that – while excess weight gain tends to occur in young adulthood – research examining effective weight gain prevention interventions for this age group has been limited. Thus, the research team worked with 441 participants (ages 18 to 35 years) who were students at three Minnesota community colleges.
The two-year intervention included a one-credit academic course designed by the research team, along with a social networking and online support intervention. Researchers assessed participants’ weight and weight-related behaviors targeted by the intervention (dietary factors, physical activity and sleep) at the baseline and at four, 12 and 24 months.
The researchers also examined effects of the intervention on 12 behavioral outcomes across three domains: diet (fast food, sugary beverages, breakfast, at-home meal preparation), physical activity/screen time (minutes and energy expenditure in leisure time physical activity, television viewing, leisure time computer use) and sleep (hours of sleep, time required to fall asleep, days not getting enough rest, difficulty staying awake).
Analysis at 24 months revealed that the intervention had resulted in significant reductions in students’ fast food consumption, but also was related to increases in their difficulty staying awake.
While evidence of change in other specific behaviors was lacking at the 24-month mark, examination of summary treatment effects – which represent the simultaneous, composite effect of the intervention across all behavioral domains – revealed that the overall intervention effect was statistically significant (p = 0.014). Examining this composite of all behaviors may reflect the flexible structure of the CHOICES intervention, which allowed participants to select the targeted behavior(s) upon which they wanted to focus during the 24-month intervention.
CHOICES’ two-year timeline is much longer than that of other interventions reported to date among the young adult age group. Post-study evaluation showed that participants’ engagement with the intervention was high during the semester-long CHOICES course and the initial months of website utilization. However (consistent with other trials using similar intervention platforms), engagement declined thereafter. Following the first four months of the intervention, results indicate that 30 to 40 percent of participants continued to engage with the CHOICES website.
As sustained participant engagement is particularly challenging among this age group, additional research is needed to understand effective obesity prevention among young adults, particularly those attending two-year and community colleges.