Effect of Combination of Behavioural Intervention and Nutrition Education with Brown Rice (COMBINE-BROWN) Weight Loss Program on Body Composition and Oxidative Stress among Overweight and Obese Adults.

The weight loss study incorporates nutrition education, exercise, and behavioral modification approach, with brown rice consumption. The study involves a 12-week intervention phase and another 12 week maintenance phase. The participants are allocated into two groups, the intervention and control group. The intervention group receives 12-week behavioral weight loss intervention study, with health education on brown rice and incorporation of brown rice as daily diet regimen. The study is conducted in Universiti Sains Malaysia, Kelantan, Malaysia. It must be emphasised that the weekly nutritional, behavioural, and exercise sessions were conducted together in the same session. Furthermore, the group sessions were conducted when there was a requirement to conduct an in-depth discussion and encouragement of peer support among the participants; meanwhile, individual sessions were conducted when there was a need for individual dietary advice or health concern. The experienced nutritionists and dietitians deliver the nutrition education modules, which will be conducted approximately one hour session for 12 weeks, using the local languages with simple sentences. These modules included general nutrition knowledge, based on Malaysian Dietary Guidelines. The healthy regimen such as Malaysian Food Pyramid and Malaysian Healthy Plate were introduced to the participants as a guideline for healthy diet (MOH, 2021). The twelves modules of the Nutrition Education Modules include Introduction of Obesity and Risk of Obesity, Obesity and Energy Balance, Food Pyramid, Food Serving Size, Carbohydrate, Fat and Protein, Weight Changes Challenges, Food Labelling, Fibre, Vitamins and Minerals, Weight Management, and Total Weight Changes. A total of 12 classes are scheduled weekly during the intervention period, using face-to-face approach. For the intervention group, the participants are prescribed with seven cups of brown rice every week and they are required to consume at least one serving of brown rice each day. The exercise components are delivered weekly by fitness instructors in groups. The exercise regimen includes brisk walking (approximately one hour), aerobic exercise (30 minutes), and dumbbell resistance exercise (30 minutes) (Matsuo and Suzuki, 1999) for 12 classes over 12 weeks intervention period. The intensity is gradually increased from low to intermediate, with about 33 in each groups. The intensity of physical activity level will be assessed using Malay version of the International Physical Activity Questionnaires (IPAQ-BM) (IPAQ, 2004). The behavioral modification approach includes goal-monitoring, individual and group counselling, self-monitoring, and problem solving (Burgess et al, 2017). For the maintenance phase, the participants are required to continue the behavioral weight loss regimen for another 12 week after the intervention. The food diary is distributed to each participants to record their daily food intakes and served as self-monitoring purposes. For individual and group counselling, the recorded food diary will be discussed individually or in group with the nutritionists or dietitians. The participants will be advised to change the type and amount of their food intakes. Moreover, for problem solving, the problem encountered and the possible solution during the weight loss will be also discussed individually or in groups with the researchers. The discussion session will be conducted approximately one hour for 12 classes over 12 weeks intervention period. The classes will be conducted using face-to-face method. The Malay version of Impact Weight of Quality of Life-LITE (Kolotkin, 2017) will be used to assess the impact of weight on quality of life among the participants. The session attendance checklist will be used to assess the attendance of the participants in the behavioural weight loss program, which integrates nutrition education modules, exercise regimen, and behavioural weight loss approach.