Physical Activity and Dietary Determinants of Weight Loss Success questions hello, please read the attached and answer these question below From this art

Physical Activity and Dietary Determinants of Weight Loss Success questions hello,

please read the attached and answer these question below

From this article please answer

1) Data Source

2) Method for acquiring data

3) Outcomes Measured

4) Positive Findings

5) Authors interpretation of findings and whether you agree AND why. There will be lots of weight on why you agree or disagree.

2 pages you maximum (400 words) AJPH RESEARCH
Physical Activity and Dietary Determinants of
Weight Loss Success in the US General Population
Patrick Wilson, PhD
Objectives. I studied lifestyle behaviors of long-term weight losers in a nationally
representative sample.
Methods. I categorized the dietary and physical activity data of 8012 adults from the
2009–2012 National Health and Nutrition Examination Surveys into (1) long-term
weight losers (‡ 10% loss for ‡ 1 year), (2) recent weight losers (‡ 10% loss within past
year), and (3) overweight or obese individuals who never lost 10% or more of their
weight.
Results. Long-term weight losers consumed fewer calories (2072; 95% con?dence
interval [CI] = 2011, 2134 kcal vs 2211; 95% CI = 2173, 2249 kcal; P < .001) and were more likely to report any vigorous leisure activity (24.5% vs 20.3%; P = .027) than did overweight or obese individuals. Among those engaging in vigorous leisure activity, longterm weight losers reported a greater quantity (188; 95% CI = 159, 223 min · wk–1 vs 156; 95% CI = 142, 172 min · wk–1; P = .047). Recent weight losers did not differ from overweight or obese individuals on absolute calorie intake but reported less fat (79; 95% CI = 75, 83 g vs 84; 95% CI = 82, 86 g; P = .016) and more activity. Conclusions. Balanced calorie restriction from all macronutrients and physical activity are important behaviors for successful long-term weight loss in the general population. (Am J Public Health. 2016;106:321–326. doi:10.2105/AJPH.2015.302956) A pproximately 17% of children and adolescents and 35% of adults in the United States are obese.1 The societal costs of obesity are staggering, with direct and indirect costs rising in a curvilinear fashion with body mass index (BMI; de?ned as weight in kilograms divided by the square of height in meters).2 On an individual level, obesity is associated with numerous deleterious health outcomes, including type II diabetes, cancer, coronary artery disease, sleep apnea, and cognitive dysfunction.3 As a result of these overwhelming societal and individual costs, much attention has been paid to evaluating the ef?cacy of various weight loss interventions. Randomized trials of diet and physical activity interventions demonstrate that substantial weight loss can be achieved by most individuals, especially during the initial 6 months of an intervention.4,5 Randomized trials of weight loss, however, are somewhat limited by the expense and dif?culty of including extended follow-up periods. In addition, weight loss February 2016, Vol 106, No. 2 AJPH usually begins to regress toward baseline after a year or more,5,6 which suggests that some of the interventions used may not be optimal for long-term weight loss maintenance. Furthermore, the individuals included in these trials represent a small segment of the general population (e.g., educated non-Hispanic White women are often overrepresented),4–6 preventing inferences about the success or failure of these interventions on a larger scale. In light of these limitations of randomized trials, observational studies have attempted to characterize lifestyle behaviors of populations that have lost a substantial amount of weight.7–11 Although these investigations provide insight into some of the behaviors associated with successful weight loss, they have either used convenience sampling11 or failed to report extensive information on dietary nutrient intakes and physical activity patterns.7–10 Consequently, the ?ndings from these investigations apply only to a select portion of the general population or lack detail on the speci?c dietary and physical activity patterns used by the most successful weight losers. The National Health and Nutrition Examination Survey (NHANES) uses a complex sampling design to achieve a representative sample of the noninstitutionalized US population. NHANES assesses the health status and lifestyle behaviors of Americans through interviews, examinations, and laboratory tests. Information on dietary intake is collected through standardized 24-hour recalls, and participants report physical activity participation and weight history. As a result, NHANES provides an opportunity to examine dietary nutrient intakes and physical activity patterns among Americans who have successfully lost weight as well as among those who have successfully maintained weight loss for a prolonged period. I compared the dietary and physical activity patterns of overweight or obese individuals with those who have maintained substantial weight loss for more than 1 year as well as those who have lost weight within the past year. METHODS I carried out a secondary data analysis using cross-sectional data from the 2009–2010 and 2011–2012 NHANES survey cycles. NHANES uses strati?ed probability sampling to achieve a representative sample of noninstitutionalized Americans. Sampling is done ABOUT THE AUTHOR Patrick B. Wilson is with the Department of Human Movement Sciences, Old Dominion University, Norfolk, VA. Correspondence should be sent to Patrick B. Wilson, PhD, 2003A Student Recreation Center, Norfolk, VA 23529 (e-mail: pbwilson@odu.edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This article was accepted October 16, 2015. doi: 10.2105/AJPH.2015.302956 Wilson Peer Reviewed Research 321 AJPH RESEARCH via stages, which consist of counties, segments, households, and individuals. Select groups are oversampled to improve the reliability estimates within those groups. For all 4 survey years, Hispanics, non-Hispanic Blacks, non-Hispanic Whites, and other races at or below 130% of the poverty level, and non-Hispanic Whites and other races aged 80 years or older were oversampled. For 2011– 2012, non-Hispanic Asians were also oversampled. Participants were interviewed in their homes and ultimately invited to receive a physical examination at a mobile examination center. Participants A total of 26 703 individuals were screened and invited to participate during the 2009– 2010 and 2011–2012 NHANES, of which 19 591 agreed to participate and completed examinations at mobile examination centers (73% response rate). Among this cohort, 11 378 were considered adults (aged ‡ 20 years). Complete data on age, gender, race/ ethnicity, education attainment, relationship status, weight history, current weight, physical activity, and dietary intake were additional eligibility criteria. I excluded women who were pregnant at the time of interviews. I did not include normal weight individuals (BMI < 25) who had never lost a substantial amount of weight (‡ 10% maximum weight) in my analysis. Furthermore, I excluded individuals who reported their lifetime maximum weight to be before adulthood, because their weight loss could have taken place during adolescence and, therefore, is not comparable with intentional weight loss during adulthood. I included 8012 adults (4103 men and 3909 women) in the analytical sample, which represented approximately 165 million Americans (Table 1). Dietary Intake Dietary intake data were collected in-person at mobile examination centers using the automated multiple pass method—an ef?cient method for collecting dietary intakes for large population studies.12 The automated multiple pass method uses a 5-step process that helps ensure participants report foods that are commonly forgotten or missed in the absence of probing. Trained NHANES 322 Research Peer Reviewed Wilson interviewers quanti?ed the types and amounts of foods and beverages (including water) consumed during the 24-hour period before the interview. Dietary interviews were conducted in a private room in mobile examination centers, and measuring guides (glasses, bowls, mugs, household spoons, measuring cups, rulers, etc.) were available to help participants accurately report quantities. The automated multiple pass method provides an accurate estimate of group energy13,14 and macronutrient15 intakes, although there has been con?icting evidence with respect to underreporting among obese participants.14,16 Details of the data processing can be found elsewhere.17,18 Nutrients I analyzed for this study were energy (absolute [kcal] and relative to body mass [kcal · kg body mass–1]), carbohydrates, total sugars, ?ber, protein, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, alcohol, and plain water. I calculated relative macronutrient contributions to total energy by multiplying total grams of each macronutrient by their respective energy density values (4, 4, and 9 kcal · g–1 for protein, carbohydrates, and fat, respectively) and dividing by total energy intake. Weight History Weight history was established with a combination of self-report questions and measured weight. Participants were asked, “How much did you weigh a year ago?” “Up to the present time, what is the most you have ever weighed?” and “How old were you then [at maximum weight]?” Maximum weight responses excluded pregnancy for women. Current weight was measured at mobile examination centers. Participants had to meet several criteria to be considered a long-term weight loser (LTWL). First, participants needed to achieve 10% or more body weight reduction on the basis of their reported maximum weight and measured current weight. I used a 10% threshold because it is associated with substantial health improvements.19 Second, their reported maximum weight had to be from 1 year ago or longer. Finally, their reported weight from 1 year ago also had to re?ect at least a 10% reduction from their maximum weight. Recent weight losers (RWLs) were participants who had achieved at least a 10% body weight reduction on the basis of their reported maximum weight and measured current weight but whose weight from 1 year ago did not re?ect at least a 10% reduction from their maximum weight. As an example, an individual with a reported maximum weight of 120 kilograms (3 years ago), a 1-year-ago weight of 118 kilograms, and a current weight of 105 kilograms would be considered an RWL. The third category of participants were those who had not lost 10% of weight on the basis of their maximum and current weights and were currently overweight or obese (BMI ‡ 25). Physical Activity Physical activity was assessed using the Global Physical Activity Questionnaire.20 The Global Physical Activity Questionnaire inquires about moderate and vigorous workand leisure-time physical activity as well as time spent biking and walking for transportation. Participants were ?rst asked if they engage in each category of physical activity during a typical week (e.g., vigorous activity at work, moderate activity in leisure time). Participants were instructed to respond “yes” only if they engage in the described activities for at least 10 continuous minutes. Participants responding “yes” to each category were then asked to report the number of days in a typical week they engage in the activity as well as the amount of time in minutes they spend doing that activity on a particular day. I calculated the prevalence of participants engaging in a particular category of physical activity. In addition, I calculated minutes · week–1 spent in each category for participants who responded “yes” to engaging in that particular category of physical activity. The Global Physical Activity Questionnaire is reliable21 and shows fair to modest validity when compared with accelerometer-based data.21,22 Furthermore, validity appears to increase when examining vigorous physical activity.21 Age, gender, race/ethnicity, education attainment, and relationship status were self-reported during household interviews. Education attainment was dichotomized (£ high school vs > high school), and 3 categories were used to de?ne relationship status
(married or living with partner; widowed,
divorced, or separated; or never married).
AJPH
February 2016, Vol 106, No. 2
AJPH RESEARCH
TABLE 1—Participants’ Demographics and Anthropometrics: National Health and Nutrition Examination Surveys, 2009–2010 and 2011–2012
LTWLs (n = 1424), Mean (95% CI) or %
RWLs (n = 1312), Mean (95% CI) or %
Overweight or Obese Individuals
(n = 5276), Mean (95% CI) or %
Age, y
52.1a (51.1, 53.3)
47.6 (46.1, 49.1)
48.6 (47.7, 49.5)
Maximum weight, kg
96.4a (94.4, 98.4)
93.9 (91.9, 95.8)
93.3 (92.4, 94.2)
Characteristic
a
Weight 1 y ago, kg
76.8 (75.5, 78.1)
a
b
88.1 (87.2, 89.1)
b
90.4 (88.5, 92.3)
Current weight, kg
76.7 (75.2, 78.1)
79.6 (77.9, 81.2)
91.2 (90.3, 92.0)
Current BMI, kg/m2
26.8a (26.4, 27.3)
27.7b (27.3, 28.2)
31.8 (31.6, 32.1)
53.0
44.4
48.5
Non-Hispanic White
71.6a
65.9
67.4
Mexican American
6.5
8.4
8.9
Other Hispanic
Non-Hispanic Black
4.8
10.4
6.5
13.7
6.2
12.5
Other
6.7
5.5
5.1
Female gender
Race/ethnicity
£ high school education
b
39.1
39.8
45.8
Married or living with partner
60.9a
54.8b
64.8
Divorced, separated, or widowed
26.0
22.9
19.0
Never married
13.1
22.3
16.3
Relationship status
Note. CI = con?dence interval; BMI = body mass index; LTWL = long-term weight loser; RWL = recent weight loser. Sample sizes represent unweighted counts.
Means and percentages are weighted to the US population.
a
Signi?cant difference (P < .05) between LTWLs and overweight or obese individuals. b Signi?cant difference (P < .05) between RWLs and overweight or obese individuals. Statistical Analysis I downloaded publically available ?les from the NHANES Web site and merged them using SAS version 9.3 (SAS Institute Inc, Cary, NC). I completed the remaining analyses using SPSS Complex Samples, version 22 (IBM, Armonk, NY). I used NHANES-supplied population weights speci?c to the dietary data to account for the complex sampling design, nonresponse, and differential allocation by day of the week for the dietary intake data. Physical activity data expressed as minutes · week–1 were highly skewed and therefore I log-transformed them and back-transformed the means for data presentation. I used the Taylor linearization method to calculate means and 95% con?dence intervals (CIs) for continuous variables. I evaluated unadjusted differences in continuous variables between groups (LTWLs, RWLs, overweight or obese individuals) using the general linear model function. I entered continuous variables as dependent variables and the grouping variable (LTWLs, RWLs, overweight or obese individuals) as the factor. I tested pairwise differences by using the estimated means February 2016, Vol 106, No. 2 AJPH function, with the overweight or obese group serving as the reference category. I examined pairwise differences for categorical variables using the Rao-Scott likelihood c2 test. To reduce the likelihood that weight changes were unintentional (owing to chronic disease), I conducted additional analyses using only participants aged between 20 and 60 years. All tests were considered signi?cant at a P < .05. RESULTS Information on demographics and anthropometrics by the 3 groups (LTWLs, RWLs, overweight or obese individuals) is reported in Table 1. LTWLs were older, were more likely to be non-Hispanic White, were less likely to be married or living with a partner, and had a higher maximum weight than did the overweight or obese individuals. As would be expected, LTWLs had a lower current weight, lower current BMI, and lower weight 1 year ago than did the overweight or obese individuals. The average time since maximum weight for LTWLs was 15.6 years (95% CI = 14.8, 16.4). RWLs did not differ from the overweight or obese individuals with respect to maximum weight but did have a higher weight 1 year ago and lower current weight and BMI. In terms of other demographic factors, RWLs had less education and were less likely to be married or living with a partner than were the overweight or obese individuals. Dietary nutrient intakes by the 3 groups are presented in Table 2. LTWLs reported consuming less absolute energy, carbohydrate, protein, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, and relative energy from fat than did the overweight or obese individuals. Energy intake standardized against body mass was higher in LTWLs than in the overweight obese. RWLs reported consuming less total fat, saturated fat, and monounsaturated fat than did the overweight or obese individuals. The percentage of energy derived from carbohydrates was higher and fat was lower in RWLs than in the overweight or obese individuals. Similar to LTWLs, RWLs had higher energy intakes standardized against body mass than did the overweight or obese individuals. In addition, RWLs consumed Wilson Peer Reviewed Research 323 AJPH RESEARCH TABLE 2—Participants’ Dietary Nutrient Intakes: National Health and Nutrition Examination Surveys, 2009–2010 and 2011–2012 Variable RWLs (n = 1312), Mean (95% CI) Overweight or Obese Individuals (n = 5276), Mean (95% CI) 2072a (2011, 2134) 2179 (2074, 2285) 2211 (2173, 2249) 28.3a (27.5, 29.1) 28.9b (27.4, 30.4) 24.7 (24.3, 25.2) 15.9 (15.4, 16.3) 15.6 (15.2, 16.1) 15.8 (15.5, 16.0) LTWLs (n = 1424), Mean (95% CI) Energy, kcal -1 Relative energy, kcal · kg body mass Energy from protein, %, Energy from carbohydrates, % Energy from fat, % 49.1 (48.3, 49.4) 49.8 (48.9, 50.6) 48.8 (48.3, 49.3) 32.6a (31.8, 33.4) 32.4b (31.6, 33.2) 33.5 (33.2, 33.8) a Protein, g Carbohydrates, g Total sugars, g Fiber, g Total fat, g b 80 (77, 83) 82 (79, 86) 85 (83, 87) 251a (244, 259) 265 (250, 279) 265 (261, 270) 113 (109, 118) 117 (107, 126) 118 (115, 121) 17 (17,18) 18 (17, 19) 18 (17, 18) 76a (73, 79) 79b (75, 83) 84 (82, 86) a b Saturated fat, g 25 (24, 26) 26 (24, 27) 27 (27, 28) Monounsaturated fat, g 28a (27, 29) 29b (27, 30) 30 (30, 31) a Polyunsaturated fat, g Alcohol, g Plain water, g 18 (17, 18) 18 (17, 19) 19 (19, 20) 12 (10, 15) 15 (10, 21) 11 (10, 13) 1065 (976, 1153) 1261b (1142, 1379) 1104 (1046, 1162) Note. CI = con?dence interval; LTWL = long-term weight loser; RWL = recent weight loser. Sample sizes represent unweighted counts. Means are weighted to the US population. a Signi?cant difference (P < .05) between LTWLs and overweight or obese individuals. b Signi?cant difference (P < .05) between RWLs and overweight or obese individuals. more plain water. All the differences in dietary nutrients remained signi?cant after excluding individuals older than 60 years, with the exception of percentage energy from carbohydrates between RWLs and the overweight or obese individuals (P = .095). The percentages of participants within each group that indicated they engaged in various categories of physical activity as well as the average time per week spent among participants that engaged in those speci?c categories are shown in Table 3. LTWLs were less likely to engage in work-related vigorous activity but more likely to engage in vigorous leisure-time activity than were the overweight or obese individuals. Among participants engaging in vigorous leisure-time activity, LTWLs averaged more minutes · week–1 than did the overweight or obese individuals. RWLs were more likely to engage in any transportation and vigorous leisure-time activity than were the overweight or obese individuals. Furthermore, RWLs spent more minutes · week–1 in moderate work-related and vigorous leisure-time activities than did the overweight or obese individuals. All the 324 Research Peer Reviewed Wilson differences in physical activity minutes · week–1 remained signi?cant after excluding individuals older than 60 years, with the exception of percentage of LTWLs and overweight or obese individuals engaging in work-related vigorous activity (P = .156) and time spent in vigorous leisure-time activities between RWLs and overweight or obese individuals (P = .072). DISCUSSION I c... Purchase answer to see full attachment