Mean Weight Change from Baseline to Months 4 and 12
Weight will be collected by study staff who are masked to treatment using scales tested monthly for accuracy up to 350 pounds.
Mean Weight Change from Baseline through Follow-Up by Sub-Groups
Weight will be collected by study staff who are masked to treatment using scales tested monthly for accuracy up to 350 pounds. Change in weight will be assessed across 3 pre-specified subgroups: 1) with vs. without diabetes; 2) females vs. males; and 3) whites vs. African Americans.
Percentage Weight from Baseline through Follow-Up
Weight will be collected by study staff who are masked to treatment using scales tested monthly for accuracy up to 350 pounds. Assess difference between study groups in percentage losing ≥ 5% body weight for all participants and across 3 pre-specified subgroups: 1) participants with vs. without diabetes; 2) females vs. males; and 3) Whites vs. African Americans.
Mean Change in Systolic Blood Pressure from Baseline through Follow-Up
Blood pressure assessed by Omron-907xl, average of 3 readings.
Mean Change in Diastolic Blood Pressure from Baseline through Follow-Up
Blood pressure assessed by Omron-907xl, average of 3 readings.
Mean Change in Total Cholesterol from Baseline through Follow-Up
Total cholesterol assessed by commercial lab (LabCorp).
Mean Change in HDL-Cholesterol from Baseline through Follow-Up
HDL-Cholesterol assessed by commercial lab (LabCorp).
Mean Change in Triglycerides from Baseline through Follow-Up
Triglycerides as assessed by commercial lab (LabCorp).
Mean Change LDL-cholesterol from Baseline through Follow-up
Calculated from above lipid assessments by commercial lab (LabCorp).
Mean Change in A1c from Baseline through Follow-Up
A1c assessed by commercial lab (LabCorp).
Mean Change in CRP from Baseline through Follow-Up
CRP assessed by commercial lab (LabCorp).
Mean Change in IL-6 from Baseline through Follow-Up
Assessed by independent lab blinded to participant arm.
Mean Change in TNF-alpha from Baseline through Follow-Up
Assessed by independent lab blinded to participant arm.
Mean Change in Skin Carotenoids from Baseline through Follow-Up
Evaluated as the sum of 3 measures assessed by veggie-meter by Longevity Link Corporation.
Mean Change in Quality of Life Scale from Baseline through Follow-Up
The Euro Quality of Life five Dimensions Questionnaire EQ-5D-5L scale measures patients' quality of healthy living. It has 5 items (Mobility, Self-care, Usual activities, Pain/discomfort, Depression/anxiety). Each item contains 5 levels: 1= no difficulty, 2= slight difficulty, 3= moderate difficulty, 4= serious difficulty, 5= extremely serious difficulty. The higher the score has the worse the health. Then, the score calculation of the European Five-Dimensional Health Scale is based on the calculation formula published by the EuroQol Group. Based on 5 combinations of different severity levels, a score of 0 to 1 is obtained. 0 is the least healthy and 1 is the most healthy.
Mean Change in Alternate Healthy Eating Index (AHEI)-2010 from Baseline through Follow-Up
The AHEI-2010 is calculated from items on the Willett Food Frequency Questionnaire. It addresses intake of foods and nutrients consistently associated with lower risk for chronic diseases in the literature. The AHEI-2010 score is comprised of 11 sub-scales, each scored from 0 to 10, yielding a total score with a range of 0-110. A higher score indicates a more healthful dietary pattern.
Mean Change in Global Physical Activity Questionnaire (GPAQ) from Baseline through Follow-Up
The GPAQ was developed by the WHO for physical activity surveillance. It collects information on physical activity participation in three settings (or domains) as well as sedentary behavior. The domains are: activity at work, travel to and from places, and recreational activities. The summary measure will be the sum of all activity per day with a higher score indication more physical activity.
Mean Change in Weight Loss Self-Efficacy from Baseline through Follow-Up
The Weight Efficacy Lifestyle Questionnaire Short-Form (WEL-SF1) is a short version of the original Weight-Efficacy Lifestyle Questionnaire and includes 8 questions and 1 situational component representing "confidence in ability to resist eating." Three of the questions are related to emotional eating situations, two to availability, one to social pressure, one to positive activities, and one to physical discomfort.
Scoring: The instrument range scores on a Likert-scale from 0 (not at all confident) to 10 (very confident), with sum scores between 0 and 80. High scores are associated with high eating self-efficacy.
Mean Change in Dietary Self-Regulation from Baseline through Follow-Up
Treatment Self-regulation Questionnaire (TSRQ) measures the quality of motivation for a particular health goal. Motivation is psychological energy directed at a particular goal such as weight loss. This measure assesses three types of motivation: autonomous self-regulation, controlled self-regulation, and a-motivation or lack of motivation. This 15-item scale will focus on the reasons why people would either start eating a healthier diet or continue to do so.
Scoring: Participants rate each statement on a 7-point Likert scale ranging from 1 (not at all true) to 7 (very true). It assesses the degree to which a person's motivation for eating a healthy diet is autonomous or self-determined. The three sub-scale scores can be used separately or a Relative Autonomous Motivation score can be calculated. A higher score indicates greater motivation.
Mean Change in Eating Attitudes from Baseline through Follow-Up
The Three Factor Eating Questionnaire (18 item revised version) measures eating attitudes with scales representing three dimensions of eating behavior: cognitive restraint (control over food intake in order to influence body weight / body shape), uncontrolled eating (loss of control over eating), and emotional eating (eating in response to positive and negative emotions).
Scoring: Each scale (dimension) is scored separately. Six of the eighteen items measure cognitive restraint, nine measure uncontrolled eating, and three measure emotional eating. Higher scores indicate greater cognitive restraint.
Mean Change in Diet Self-Efficacy from Baseline through Follow-Up
Perceived self-efficacy is regarded as a suitable predictor of behavioral intentions and reported health behaviors. This 5-item scale of perceived self-efficacy measuring action self-efficacy and coping self-efficacy related to healthful eating behaviors. Responses are on a 4-point scale of 'very uncertain' to 'very certain.'
Scoring: Higher scores indicate higher perceived self-efficacy.
Validation: Evidence for the validity of the scales has been published in several articles. Cronbach's alpha for the nutrition self-efficacy measure ranges from 0.79 to 0.85.
Mean Change in Self-Weighing Behaviors from Baseline through Follow-Up
EARLY Self-Weighing Questionnaire: This is a 2-item screener measures frequency of self-weighing and access to a bathroom scale. It was adapted from the Pound of Prevention Health Habits Questionnaire, Year 2. Validity of construct confirmed in Linde et al, 2005, as reports of higher weighing frequency was associated with greater 24-month weight loss or less weight gain.
Scoring: Higher scores indicate higher frequency of self-weighing and access to a bathroom scale.
Economic Outcome--Incremental Cost-Effectiveness
Computed as the incremental cost per kilogram of weight loss relative to control.
The budgetary assessment will quantify the total and per participant costs of intervention delivery from the health system perspective using an Activity Based Costing (ABC) approach and cost tracking forms that the health economist (Finkelstein) has developed and refined in past behavioral trials. Using this approach, all relevant labor, materials and supplies, contracted services, and other relevant costs required to deliver the interventions will be captured by key activities
Economic Outcome--Incremental Cost per Quality Adjusted Life Year (QALY) gained
The numerator for this analysis will be the incremental program delivery costs of the intervention relative to control, minus any cost offsets based on differences in health services and medication use across arms. The denominator will be the incremental QALYs based on average differences in Euro Quality of Life five Dimensions Questionnaire (EQ-5D-5L) scores across arms collected at each assessment point. These scores can be used to quantify net QALY differences during the intervention period.
EQ-5D-5L scale measures patients' quality of healthy living. It has 5 items (Mobility, Self-care, Usual activities, Pain/discomfort, Depression/anxiety). The score calculation of the European Five-Dimensional Health Scale is based on the calculation formula published by the EuroQol Group. Based on 5 combinations of different severity levels, a score of 0 to 1 is obtained. 0 is the least healthy and 1 is the most healthy.