Obesity
Conditions
Keywords
behavioral weight loss intervention, obesity
Brief summary
The proposed pilot study will examine cooking as an intervention target for weight control in overweight adults. The study will also examine whether interventions designed to promote cooking at home can increase participants' sense of food agency, and overcome common barriers to cooking at home such as time scarcity and budget constrictions. The study will utilize a cooking pedagogy designed to not just teach participants the basics of cooking different foods, but how to be efficient, mindful cooks. If cooking class participation positively impacts diet and health outcomes, it will bolster the case for promoting cooking at home as a health behavior for multiple populations.
Detailed description
A two arm randomized control trial will examine whether the addition of an active cooking lesson versus a passive observed lesson to a behavioral weight loss intervention results in significantly greater weight loss. Additionally, the study will examine whether interventions designed to promote cooking at home can increase participants' sense of food agency, and overcome common barriers to cooking at home such as time scarcity and budget constrictions. Overweight and obese but otherwise healthy participants (n=64) will be recruited. Recruitment and study initiation will occur in two waves. Wave 1 aims to recruit 32 individuals who will then be randomized to 1) a 24 week, 24 session group behavioral weight loss intervention with 12 bi-weekly cooking lessons; or, 2) the same 24 week, 24 session group behavioral weight loss intervention with 12 bi-weekly cooking demonstrations. Both groups get the same intervention and the same counselor delivered intervention elements; the presence of active cooking lessons vs. passive observed cooking demonstrations is the only difference between conditions. Assessments will be conducted at 0, 3 and 6 months. Wave 2 (n=32) will follow the same process as Wave 1 approximately two months after Wave 1 is initiated.
Interventions
BEHAVIORALActive Intervention - Cooking
Key behavioral strategies to facilitate making sustained changes in dietary habits and activity patterns are introduced, promoted and reinforced throughout the program. In-person sessions facilitated by an interventionist provide the group meetings. The program provides 24 weekly facilitated group sessions over 6 months. In addition to attending weekly classes, participants will track food intake, exercise, and weight. Participants will share online tracking diaries with the group facilitator who will offer individualized feedback on individual progress. Twelve cooking classes will be run every other week after the in-person weight loss meetings.
BEHAVIORALDemonstrations - Cooking
The Demonstrations group will receive the exact same behavioral weight loss intervention as the cooking group. The only difference is that this group will attend cooking demonstrations as opposed to actively cooking.
Sponsors
University of Vermont
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
The Behavioral Weight Loss Program: Investigators have developed and implemented a theory-based group-delivered behavioral weight control program in two previous studies that incorporates the elements of current thinking and empirical data on successful weight loss programs, including restricted calorie intake and increased physical activity. In addition to attending weekly classes, participants will track their food intake, exercise, and weight. Participants will share online tracking diaries with the group facilitator who will offer individualized feedback on progress. The Cooking Program Active Intervention. Twelve cooking classes will be run every other week after the in-person weight loss meetings. Demonstrations. The demonstration condition will serve as an attention only control. All participants will have an opportunity to sample the prepared food at the end of class. The demonstrations will be led by the same chef as the active intervention group.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* only individuals who are cooking (from scratch) no more than 3 meals at home per week will be eligible. * must have a computer or smart device with internet access (at home or work) in order to track their diet and exercise behaviors, * potential participants will be required to demonstrate some ability to comply with study intervention procedures to be eligible (specifically, they must complete an online dietary self-monitoring diary for 3 days) * must be at least 18 years old and have a BMI between 25-50 kg/m2 * must agree to be randomized to either study arm and available for both scheduled meeting times in person on the University of Vermont campus
Exclusion criteria
* pregnant or planning to become pregnant in the next 6 months or lactating * physical conditions that would preclude exercise * medication affecting weight loss * currently enrolled in another weight loss program * currently cooking more than 3 meals from scratch at home per week
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Weight Change | 24 weeks | Weight loss from baseline at 24 weeks |
| Change From Baseline in the Total HEI Score, as a Measure of Diet Quality Change | Baseline and 24 weeks | Difference in diet quality change between groups across assessments. Measured by Healthy Eating Index scores. The HEI includes 13 components that capture recommendations of the 2015-2020 Dietary Guidelines for Americans. There are two groupings of components: 1. Adequacy components are encouraged. Higher scores reflect higher intakes. 2. Moderation components should be limited. Higher scores reflect lower intakes. A higher total HEI score reflects higher diet quality as defined by the Dietary Guidelines for Americans. Components are weighted equally and assigned a score of either 5 or 10. Scores as summed to determine total score. The minimum possible score is 0 and the maximum possible is 100. Adequacy Components: Total Fruits 5 Whole Fruits 5 Total vegetables 5 Greens and beans 5 Whole grains 10 Dairy 10 Total protein foods 5 Seafood and plant proteins 5 Fatty acids 10 Moderation Components: Refined grains 10 Sodium 10 Added sugars 10 Saturated fats 10 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cooking and Food Practices Change - Attitude Subscale | 24 weeks | Difference in baseline and end point Cooking and Food Provisioning Action Scale Attitude subscale scores between groups. Structure subscale measures an individual's affective stance towards food, cooking and provisioning in different areas. On a scale of 1-7, higher scores over time indicate improvement. |
| Cooking and Food Practices Change - Self Efficacy Subscale | 24 weeks | Difference in baseline and end point Cooking and Food Provisioning Action Scale Self Efficacy subscale scores between groups. Structure subscale measures whether an individual thinks their cooking ability and skills are adequate. On a scale of 1-7, higher scores over time indicate improvement. |
| Cooking Frequency Change - Breakfast | 24 weeks | Breakfast cooking frequency was assessed at baseline and 24 weeks using the cooking frequency subscale from the Cooking Perceptions/Attitudes/Confidence/Behaviors Survey. The scores range from a minimum of 0 to a maximum of 7 meals cooked during a one week period. |
| Cooking and Food Practices Change - Total Score | 24 weeks | Difference in baseline and end point Cooking and Food Provisioning Action Scale Total scores between groups. Structure subscale measures whether an individual thinks their cooking ability and skills are adequate. On a scale of 1-21, higher scores over time indicate improvement. |
| Cooking Frequency Change - Dinner | 24 weeks | Dinner cooking frequency was assessed at baseline and 24 weeks using the cooking frequency subscale from the Cooking Perceptions/Attitudes/Confidence/Behaviors Survey. The scores range from a minimum of 0 to a maximum of 7 meals cooked during a one week period. |
| Treatment Engagement- Attendance | 24 weeks | Percent (of 24 possible) classes attended will be calculated to determine treatment engagement |
| Treatment Engagement- Food Journaling Compliance | Baseline to six months | Percent of weekly food journals at least partially completed (an entry made during a seven day period) will be calculated to determine treatment engagement |
| Cooking Frequency Change - Lunch | 24 weeks | Lunch cooking frequency was assessed at baseline and 24 weeks using the cooking frequency subscale from the Cooking Perceptions/Attitudes/Confidence/Behaviors Survey. The scores range from a minimum of 0 to a maximum of 7 meals cooked during a one week period. |
| Cooking and Food Practices Change - Structure Subscale | 24 weeks | Difference in baseline and end point Cooking and Food Provisioning Action Scale Structure subscale scores between groups. Structure subscale measures the ways in which external factors can either hinder or support an individual's cooking and provisioning actions. On a scale of 1-7, higher scores over time indicate improvement. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Active Intervention - Cooking Twelve cooking classes will be run every other week after the in-person weight loss meetings. These lessons will be patterned after Dr. Amy Trubek's cooking pedagogy and will be tailored for individuals specifically interested in weight loss. Classes will begin with a brief lecture on the day's topic, followed by a laboratory session. Participants work in teams of two in the University of Vermont Nutrition and Food Sciences department foods lab to actively practice skills and cook a meal. Subjects will receive recipes and information sheets that cover pantry supplies, grocery lists, knife skills and cooking equipment. Classes will be taught by a chef trained in the pedagogy by Dr. Trubek and participants will have the opportunity to sample the food they prepared at the end of class.
Active Intervention - Cooking: Key behavioral strategies to facilitate making sustained changes in dietary habits and activity patterns are introduced, promoted and reinforced throughout the program. In-person sessions facilitated by an interventionist provide the group meetings. The program provides 24 weekly facilitated group sessions over 6 months. In addition to attending weekly classes, participants will track food intake, exercise, and weight. Participants will share online tracking diaries with the group facilitator who will offer individualized feedback on individual progress.
Twelve cooking classes will be run every other week after the in-person weight loss meetings. | 28 |
| Demonstrations - Cooking The demonstration condition will serve as an attention only control. Previous research suggests that demonstrations of cooking have little to no impact on cooking behavior, therefore, cooking demonstrations can be used to even out the time and attention devoted to the active cooking participants without introducing bias into the study design. Subjects in the demonstration condition will also begin with a brief lecture on the day's lesson followed by a cooking demonstration that covers the same topics as the active intervention group. All participants will receive the same printed information and also have an opportunity to sample the prepared food at the end of class. The demonstrations will be led by the same chef as the active intervention group.
Demonstrations - Cooking: The Demonstrations group will receive the exact same behavioral weight loss intervention as the cooking group. The only difference is that this group will attend cooking demonstrations as opposed to actively cooking. | 28 |
| Total | 56 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 3 | 6 |
| Overall Study | Protocol Violation | 0 | 1 |
Baseline characteristics
| Characteristic | Active Intervention - Cooking | Demonstrations - Cooking | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 1 Participants | 0 Participants | 1 Participants |
| Age, Categorical Between 18 and 65 years | 27 Participants | 28 Participants | 55 Participants |
| Age, Continuous | 55 years STANDARD_DEVIATION 11 | 50 years STANDARD_DEVIATION 11 | 53 years STANDARD_DEVIATION 11 |
| Education College Degree | 10 Participants | 15 Participants | 25 Participants |
| Education Graduate Degree, Professional Education | 10 Participants | 6 Participants | 16 Participants |
| Education High School graduate, GED, Some college | 8 Participants | 7 Participants | 15 Participants |
| Employment Disabled | 1 Participants | 1 Participants | 2 Participants |
| Employment Employed | 23 Participants | 26 Participants | 49 Participants |
| Employment Homemaker | 1 Participants | 0 Participants | 1 Participants |
| Employment Not currently employed | 1 Participants | 0 Participants | 1 Participants |
| Employment Retired | 2 Participants | 1 Participants | 3 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 1 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 28 Participants | 27 Participants | 55 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Marital Status Divorced | 5 Participants | 4 Participants | 9 Participants |
| Marital Status Married | 16 Participants | 17 Participants | 33 Participants |
| Marital Status Never Married | 6 Participants | 6 Participants | 12 Participants |
| Marital Status Separated | 0 Participants | 1 Participants | 1 Participants |
| Marital Status Widowed | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Latino or Hispanic American | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Middle Eastern or Arab American | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Non-Hispanic White or Euro-American | 28 Participants | 24 Participants | 52 Participants |
| Race/Ethnicity, Customized Other | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Prefer not to answer | 0 Participants | 1 Participants | 1 Participants |
| Region of Enrollment United States | 28 participants | 28 participants | 56 participants |
| Sex: Female, Male Female | 25 Participants | 25 Participants | 50 Participants |
| Sex: Female, Male Male | 3 Participants | 3 Participants | 6 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 28 | 0 / 28 |
| other Total, other adverse events | 0 / 28 | 0 / 28 |
| serious Total, serious adverse events | 0 / 28 | 0 / 28 |
Outcome results
Primary
Change From Baseline in the Total HEI Score, as a Measure of Diet Quality Change
Difference in diet quality change between groups across assessments. Measured by Healthy Eating Index scores. The HEI includes 13 components that capture recommendations of the 2015-2020 Dietary Guidelines for Americans. There are two groupings of components: 1. Adequacy components are encouraged. Higher scores reflect higher intakes. 2. Moderation components should be limited. Higher scores reflect lower intakes. A higher total HEI score reflects higher diet quality as defined by the Dietary Guidelines for Americans. Components are weighted equally and assigned a score of either 5 or 10. Scores as summed to determine total score. The minimum possible score is 0 and the maximum possible is 100. Adequacy Components: Total Fruits 5 Whole Fruits 5 Total vegetables 5 Greens and beans 5 Whole grains 10 Dairy 10 Total protein foods 5 Seafood and plant proteins 5 Fatty acids 10 Moderation Components: Refined grains 10 Sodium 10 Added sugars 10 Saturated fats 10
Time frame: Baseline and 24 weeks
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Active Intervention - Cooking | Change From Baseline in the Total HEI Score, as a Measure of Diet Quality Change | 6.08 points | Standard Deviation 2.62 |
| Demonstrations - Cooking | Change From Baseline in the Total HEI Score, as a Measure of Diet Quality Change | 6.23 points | Standard Deviation 2.84 |
p-value: 0.97Mixed Models Analysis
Primary
Weight Change
Weight loss from baseline at 24 weeks
Time frame: 24 weeks
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Active Intervention - Cooking | Weight Change | 7.34 kilogram | Standard Deviation 0.63 |
| Demonstrations - Cooking | Weight Change | 4.49 kilogram | Standard Deviation 0.67 |
p-value: 0.003Mixed Models Analysis
Secondary
Cooking and Food Practices Change - Attitude Subscale
Difference in baseline and end point Cooking and Food Provisioning Action Scale Attitude subscale scores between groups. Structure subscale measures an individual's affective stance towards food, cooking and provisioning in different areas. On a scale of 1-7, higher scores over time indicate improvement.
Time frame: 24 weeks
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Active Intervention - Cooking | Cooking and Food Practices Change - Attitude Subscale | Attitude baseline | 4.45 score on a scale | Standard Error 0.17 |
| Active Intervention - Cooking | Cooking and Food Practices Change - Attitude Subscale | Attitude 24 weeks | 5.31 score on a scale | Standard Error 0.18 |
| Demonstrations - Cooking | Cooking and Food Practices Change - Attitude Subscale | Attitude baseline | 4.32 score on a scale | Standard Error 0.17 |
| Demonstrations - Cooking | Cooking and Food Practices Change - Attitude Subscale | Attitude 24 weeks | 5.37 score on a scale | Standard Error 0.19 |
p-value: 0.4Mixed Models Analysis
p-value: <0.001Mixed Models Analysis
p-value: <0.001Mixed Models Analysis
Secondary
Cooking and Food Practices Change - Self Efficacy Subscale
Difference in baseline and end point Cooking and Food Provisioning Action Scale Self Efficacy subscale scores between groups. Structure subscale measures whether an individual thinks their cooking ability and skills are adequate. On a scale of 1-7, higher scores over time indicate improvement.
Time frame: 24 weeks
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Active Intervention - Cooking | Cooking and Food Practices Change - Self Efficacy Subscale | Self Efficacy baseline | 3.59 score on a scale | Standard Error 0.15 |
| Active Intervention - Cooking | Cooking and Food Practices Change - Self Efficacy Subscale | Self Efficacy 24 weeks | 4.65 score on a scale | Standard Error 0.17 |
| Demonstrations - Cooking | Cooking and Food Practices Change - Self Efficacy Subscale | Self Efficacy baseline | 3.35 score on a scale | Standard Error 0.15 |
| Demonstrations - Cooking | Cooking and Food Practices Change - Self Efficacy Subscale | Self Efficacy 24 weeks | 4.70 score on a scale | Standard Error 0.18 |
p-value: 0.25Mixed Models Analysis
p-value: <0.001Mixed Models Analysis
p-value: <0.001Mixed Models Analysis
Secondary
Cooking and Food Practices Change - Structure Subscale
Difference in baseline and end point Cooking and Food Provisioning Action Scale Structure subscale scores between groups. Structure subscale measures the ways in which external factors can either hinder or support an individual's cooking and provisioning actions. On a scale of 1-7, higher scores over time indicate improvement.
Time frame: 24 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Active Intervention - Cooking | Cooking and Food Practices Change - Structure Subscale | Structure baseline | 3.20 score on a scale | Standard Error 0.19 |
| Active Intervention - Cooking | Cooking and Food Practices Change - Structure Subscale | Structure 24 weeks | 3.37 score on a scale | Standard Error 0.2 |
| Demonstrations - Cooking | Cooking and Food Practices Change - Structure Subscale | Structure baseline | 2.74 score on a scale | Standard Error 0.19 |
| Demonstrations - Cooking | Cooking and Food Practices Change - Structure Subscale | Structure 24 weeks | 3.32 score on a scale | Standard Error 0.21 |
p-value: 0.18Mixed Models Analysis
p-value: 0.4Mixed Models Analysis
p-value: 0.01Mixed Models Analysis
Secondary
Cooking and Food Practices Change - Total Score
Difference in baseline and end point Cooking and Food Provisioning Action Scale Total scores between groups. Structure subscale measures whether an individual thinks their cooking ability and skills are adequate. On a scale of 1-21, higher scores over time indicate improvement.
Time frame: 24 weeks
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Active Intervention - Cooking | Cooking and Food Practices Change - Total Score | Total Score baseline | 11.25 score on a scale | Standard Error 0.37 |
| Active Intervention - Cooking | Cooking and Food Practices Change - Total Score | Total Score 24 weeks | 13.34 score on a scale | Standard Error 0.4 |
| Demonstrations - Cooking | Cooking and Food Practices Change - Total Score | Total Score baseline | 10.41 score on a scale | Standard Error 0.37 |
| Demonstrations - Cooking | Cooking and Food Practices Change - Total Score | Total Score 24 weeks | 13.4 score on a scale | Standard Error 0.41 |
p-value: 0.08Mixed Models Analysis
p-value: <0.001Mixed Models Analysis
p-value: <0.001Mixed Models Analysis
Secondary
Cooking Frequency Change - Breakfast
Breakfast cooking frequency was assessed at baseline and 24 weeks using the cooking frequency subscale from the Cooking Perceptions/Attitudes/Confidence/Behaviors Survey. The scores range from a minimum of 0 to a maximum of 7 meals cooked during a one week period.
Time frame: 24 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Active Intervention - Cooking | Cooking Frequency Change - Breakfast | Breakfast baseline | 2.46 meals cooked | Standard Error 0.37 |
| Active Intervention - Cooking | Cooking Frequency Change - Breakfast | Breakfast 24 weeks | 2.82 meals cooked | Standard Error 0.41 |
| Demonstrations - Cooking | Cooking Frequency Change - Breakfast | Breakfast baseline | 1.54 meals cooked | Standard Error 0.37 |
| Demonstrations - Cooking | Cooking Frequency Change - Breakfast | Breakfast 24 weeks | 1.07 meals cooked | Standard Error 0.34 |
p-value: 0.26Mixed Models Analysis
p-value: 0.41Mixed Models Analysis
p-value: 0.02Mixed Models Analysis
Secondary
Cooking Frequency Change - Dinner
Dinner cooking frequency was assessed at baseline and 24 weeks using the cooking frequency subscale from the Cooking Perceptions/Attitudes/Confidence/Behaviors Survey. The scores range from a minimum of 0 to a maximum of 7 meals cooked during a one week period.
Time frame: 24 weeks
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Active Intervention - Cooking | Cooking Frequency Change - Dinner | Dinner baseline | 2.57 meals cooked | Standard Error 0.33 |
| Active Intervention - Cooking | Cooking Frequency Change - Dinner | Dinner 24 weeks | 3.37 meals cooked | Standard Error 0.36 |
| Demonstrations - Cooking | Cooking Frequency Change - Dinner | Dinner baseline | 3.25 meals cooked | Standard Error 0.33 |
| Demonstrations - Cooking | Cooking Frequency Change - Dinner | Dinner 24 weeks | 4.38 meals cooked | Standard Error 0.39 |
p-value: 0.58Mixed Models Analysis
p-value: 0.05Mixed Models Analysis
p-value: 0.01Mixed Models Analysis
Secondary
Cooking Frequency Change - Lunch
Lunch cooking frequency was assessed at baseline and 24 weeks using the cooking frequency subscale from the Cooking Perceptions/Attitudes/Confidence/Behaviors Survey. The scores range from a minimum of 0 to a maximum of 7 meals cooked during a one week period.
Time frame: 24 weeks
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Active Intervention - Cooking | Cooking Frequency Change - Lunch | Lunch baseline | 1.07 meals cooked | Standard Error 0.34 |
| Active Intervention - Cooking | Cooking Frequency Change - Lunch | Lunch 24 weeks | 2.17 meals cooked | Standard Error 0.38 |
| Demonstrations - Cooking | Cooking Frequency Change - Lunch | Lunch baseline | 1.07 meals cooked | Standard Error 0.34 |
| Demonstrations - Cooking | Cooking Frequency Change - Lunch | Lunch 24 weeks | 3.58 meals cooked | Standard Error 0.4 |
p-value: 0.03Mixed Models Analysis
p-value: 0.02Mixed Models Analysis
p-value: <0.001Mixed Models Analysis
Secondary
Treatment Engagement- Attendance
Percent (of 24 possible) classes attended will be calculated to determine treatment engagement
Time frame: 24 weeks
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Active Intervention - Cooking | Treatment Engagement- Attendance | 83 percentage of classes attended |
| Demonstrations - Cooking | Treatment Engagement- Attendance | 69 percentage of classes attended |
p-value: 0.009Wilcoxon (Mann-Whitney)
Secondary
Treatment Engagement- Food Journaling Compliance
Percent of weekly food journals at least partially completed (an entry made during a seven day period) will be calculated to determine treatment engagement
Time frame: Baseline to six months
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Active Intervention - Cooking | Treatment Engagement- Food Journaling Compliance | 95.92 percentage of complete food journals |
| Demonstrations - Cooking | Treatment Engagement- Food Journaling Compliance | 87.75 percentage of complete food journals |
p-value: 0.12Wilcoxon (Mann-Whitney)