Theodore Kyle - Academia.edu (original) (raw)

Papers by Theodore Kyle

Obesity, 2020

Research on lifestyle changes during the COVID-19 pandemic often relies on Likert-type scale ques... more Research on lifestyle changes during the COVID-19 pandemic often relies on Likert-type scale question surveys. Survey participants respond to questions by selecting one of the numerically ordered choices, "Strongly Disagree"=1, "Disagree"=2, "Neutral"=3, "Agree"=4, and "Strongly Agree"=5. Analyzing Likert-type data requires statistical methods beyond approaches like linear regression. First, it is unclear if the distance between choices are truly equal. For example, are "Agree" and "Strongly Agree" more close than "Neutral" and "Agree? Second, summarizing results using traditional means makes little sense. For example, would a mean of 4.5 imply "Agree and a half"? Finally, participants tend to select more central choices and less extremes.

Obesity, 2020

Research on lifestyle changes during the COVID-19 pandemic often relies on Likert-type scale ques... more Research on lifestyle changes during the COVID-19 pandemic often relies on Likert-type scale question surveys. Survey participants respond to questions by selecting one of the numerically ordered choices, "Strongly Disagree"=1, "Disagree"=2, "Neutral"=3, "Agree"=4, and "Strongly Agree"=5. Analyzing Likert-type data requires statistical methods beyond approaches like linear regression. First, it is unclear if the distance between choices are truly equal. For example, are "Agree" and "Strongly Agree" more close than "Neutral" and "Agree? Second, summarizing results using traditional means makes little sense. For example, would a mean of 4.5 imply "Agree and a half"? Finally, participants tend to select more central choices and less extremes.

The article aims to explore multiple causative pathways by which obesity may worsen risk Individu... more The article aims to explore multiple causative pathways by which obesity may worsen risk Individuals with obesity face not only unique biologic vulnerabilities and structural disparities but also weight stigma that deepens health inequities in the face of a pandemic The deleterious effect of weight bias falls disproportionately on the minority and socioeconomically disadvantaged groups most affected by obesity, structural barriers to health, racism, and other forms of discrimination It therefore exacerbates inequities now painfully evident in COVID-19 cases and mortality First, further research is needed to quantify the impact of healthcare avoidance for COVID- and non-COVID-related medical needs Patients with stigmatized medical conditions like obesity are at particular risk Time from symptoms to presentation is one important measure of delayed care which has not entered published models of obesity, comorbidities, and COVID-19 Second, in words and actions, we must actively affirm t...

Nursing Clinics of North America, 2021

Through four decades of rising obesity, health policy has been mostly ineffective. Prevention pol... more Through four decades of rising obesity, health policy has been mostly ineffective. Prevention policies failed to reverse rising trends in prevalence, partly because they are often based on biased mental models about what should work to prevent obesity, rather than empiric evidence for what does work. Bias toward people living with obesity harms health, while contributing to poor access to effective care that might serve to improve it. Better public policy will come from an increased application of objective obesity science, research to fill knowledge gaps, and respect for the human dignity of people who live with obesity.

Obesity, 2021

Obesity affects 158 million youth worldwide and is associated with psychosocial comorbidity. This... more Obesity affects 158 million youth worldwide and is associated with psychosocial comorbidity. This review describes weight management options utilized by adolescents, including both self‐directed weight loss and medically supervised obesity treatment interventions, and associated psychosocial impacts. A majority of adolescents with obesity attempt to manage weight on their own, primarily through attempting weight loss, sometimes with supplement use. Approaches such as these are associated with a degree of risk, disordered eating behaviors, and further weight gain. In contrast, medically supervised multicomponent interventions are associated with improved psychosocial health, including quality of life, self‐esteem, and body image, and reduced symptoms of depression, anxiety, and eating disorders. Few studies utilizing antiobesity pharmacotherapy have reported psychosocial outcomes, and trials of bariatric surgery show some early improvements with a need for sustained psychological support following surgery. Greater access to medically supervised treatment services is required to facilitate obesity care for adolescents. Early data on psychosocial health and obesity treatment offer promising outcomes; however, larger randomized controlled trials and longer‐term data are needed. Future research should include both physiological and psychosocial outcomes to assess impact of interventions on the holistic health of adolescents with obesity.

Obesity, 2021

TO THE EDITOR: We read with great interest the special issue of Obesity devoted to the weightredu... more TO THE EDITOR: We read with great interest the special issue of Obesity devoted to the weightreduced state. This is a subject of great interest to researchers, clinicians, and people living with obesity. However, we note the unfortunate use of pejorative language in the article by Aronne et al.: “Describing the WeightReduced State: Physiology, Behavior, and Interventions.” (1) Specifically, the authors describe weight regain— a common biological phenomenon in obesity treatment— as “recidivism.” This language has no place in the clinical literature regarding obesity. Recidivism is a term defined as “the act or habit of continuing to commit crimes, and seeming unable to stop, even after being punished” (2). Having obesity, seeking treatment, and encountering weight regain after treatment have nothing to do with criminal behavior and punishment. Sogg, Grupski, and Dixon explained this in 2018 (3):

International Journal of Obesity, 2020

Nutrition & Diabetes, 2020

The dietary supplement industry has estimated sales of over 30billionintheUSandover30 billion in the US and over 30billionintheUSandover100 b... more The dietary supplement industry has estimated sales of over 30billionintheUSandover30 billion in the US and over 30billionintheUSandover100 billion globally. Many consumers believe that dietary supplements are safer and possibly more effective than drugs to treat diabetes. The sheer volume of the literature in this space makes compiling them into one review challenging, so much so that primarily narrative reviews currently exist. By applying the interactive database supplied by the Office of Dietary Supplements at the National Institutes of Health, we identified the top 100 ingredients that appeared most often in dietary supplement products. One-hundred different keyword searches using the ingredient name and the word diabetes were performed using a program developed to automatically scrape PubMed. Each search was retained in a separate Excel spreadsheet, which was then reviewed for inclusion or exclusion. The studies that met the inclusion criteria were evaluated for effect of reducing and controlling diabetes. The PubMed sc...

The American Journal of Clinical Nutrition, 2021

Background The Administrative Procedure Act of 1946 guarantees the public an opportunity to view ... more Background The Administrative Procedure Act of 1946 guarantees the public an opportunity to view and comment on the 2020 Dietary Guidelines as part of the policymaking process. In the past, public comments were submitted by postal mail or public hearings. The convenience of public comment through the Internet has generated increased comment volume, making manual analysis challenging. Objectives To apply natural language processing (NLP NLP is natural language processing.) to identify sentiment, emotion, and themes in the 2020 Dietary Guidelines public comments. Methods Written comments to the Scientific Report of the 2020 Dietary Guidelines Advisory Committee that were uploaded and visible at https://beta.regulations.gov/docket/FNS-2020-0015 were extracted using a computer program and retained for analysis. All comments were filtered, and duplicates were removed. A 2-round latent Dirichlet analysis (LDA) was used to identify 3 overarching topics as well as subtopics addressed in the...

Nutrients, 2020

We read with interest the publication by Lightowler et al [...]

Obesity, 2019

Six years after the American Medical Association recognized obesity as a complex chronic disease ... more Six years after the American Medical Association recognized obesity as a complex chronic disease (1), progress continues toward more effectively managing it as one. New research from Thomas et al. (2) in this issue of Obesity suggests once again that some of the tools that we have for obesity care are barely being used. Their study examined the use of weight management medications among more than 153,000 patients with obesity or with overweight and obesity-related comorbidities who enrolled in the Veterans Health Administration’s MOVE! program (a nationwide multicomponent weight management program) between October 2013 and September 2016. They found that 99% of these veterans who enrolled in MOVE! and were eligible for weight-management medications did not receive any prescription for an antiobesity medication within 1 year of the MOVE! initiation date.

BMC Public Health, 2019

Background A key objective of this study was to examine obesity care attitudes and behaviors of p... more Background A key objective of this study was to examine obesity care attitudes and behaviors of people with obesity (PwO) and determine independent factors associated with a self-reported sustained weight loss success outcome. Methods An online survey was conducted in 2015 among 3008 U.S. adult PwO (BMI > 30 through self-reported height and weight). Multivariate logistic models explained variation in weight loss success, defined as ≥ 10% weight loss in previous 3 years and maintained for > 1 year. Results Controlling for weight changes over time, we found significant associations between self-reported weight history and weight loss success. PwO who had personal motivation to lose weight, were willing to talk to a diabetes educator about their weight, who had their weight loss attempts recognized by a healthcare provider, and were diagnosed with “obesity” or “overweight” were more likely to report having success losing weight. Conclusions This study does not determine causality...

Obesity Reviews, 2019

Being able to draw accurate conclusions from childhood obesity trials is important to make advanc... more Being able to draw accurate conclusions from childhood obesity trials is important to make advances in reversing the obesity epidemic. However, obesity research sometimes is not conducted or reported to appropriate scientific standards. To constructively draw attention to this issue, we present 10 errors that are commonly committed, illustrate each error with examples from the childhood obesity literature, and follow with suggestions on how to avoid these errors. These errors are as follows: using self‐reported outcomes and teaching to the test; foregoing control groups and risking regression to the mean creating differences over time; changing the goal posts; ignoring clustering in studies that randomize groups of children; following the forking paths, subsetting, p‐hacking, and data dredging; basing conclusions on tests for significant differences from baseline; equating “no statistically significant difference” with “equally effective”; ignoring intervention study results in favor of observational analyses; using one‐sided testing for statistical significance; and stating that effects are clinically significant even though they are not statistically significant. We hope that compiling these errors in one article will serve as the beginning of a checklist to support fidelity in conducting, analyzing, and reporting childhood obesity research.

Journal of Medical Economics, 2019

Abstract Aims: To estimate the long-term budget impact of expanding Medicare coverage of anti-obe... more Abstract Aims: To estimate the long-term budget impact of expanding Medicare coverage of anti-obesity interventions among adults aged 65 and older in the US. Materials and methods: This study analyzed a representative sample of Medicare beneficiaries from the combined 2008–2016 National Health and Nutrition Examination Surveys. Population characteristics, cost and effectiveness of anti-obesity interventions, and the sustainability of weight loss in real-life were modeled to project the budgetary impact on gross Medicare outlay over 10 years. Hypothetical scenarios of 50% and 67% increases in intervention participation above base case were used to model moderate and extensive Medicare coverage expansion of intensive behavior therapy and pharmacotherapy. Results: For each Medicare beneficiary receiving anti-obesity treatment, we estimate Medicare savings of 6,842and6,842 and 6,842and7,155 over 10 years under moderate and extensive coverage utilization assumptions, respectively. The average cost of intervention is 1,798and1,798 and 1,798and1,886 per treated participant. Taking the entire Medicare population (treated and untreated) into consideration, the estimated 10-year budget savings per beneficiary are 308and308 and 308and339 under moderate and extensive assumptions, respectively. Sensitivity analysis of drug adherence rate and weight-loss efficacy indicated a potential variation of budget savings within 7% and 22% of the base case, respectively. Most of the projected cost savings come from lower utilization of ambulatory services and prescription drugs. Limitations: Due to the scarcity of studies on the efficacy of pharmacotherapy among older adults with obesity, the simulated weight loss and long-term maintenance effects were derived from clinical trial outcomes, in which older adults were mostly excluded from participation. The model did not include potential side-effects from anti-obesity medications and associated costs. Conclusions: This analysis suggests that expanding coverage of anti-obesity interventions to eligible individuals could generate 20–20–20–23 billion budgetary savings to Medicare over 10 years.

Preventive Medicine Reports, 2019

Obesity, 2020

Research on lifestyle changes during the COVID-19 pandemic often relies on Likert-type scale ques... more Research on lifestyle changes during the COVID-19 pandemic often relies on Likert-type scale question surveys. Survey participants respond to questions by selecting one of the numerically ordered choices, "Strongly Disagree"=1, "Disagree"=2, "Neutral"=3, "Agree"=4, and "Strongly Agree"=5. Analyzing Likert-type data requires statistical methods beyond approaches like linear regression. First, it is unclear if the distance between choices are truly equal. For example, are "Agree" and "Strongly Agree" more close than "Neutral" and "Agree? Second, summarizing results using traditional means makes little sense. For example, would a mean of 4.5 imply "Agree and a half"? Finally, participants tend to select more central choices and less extremes.

Obesity, 2020

Research on lifestyle changes during the COVID-19 pandemic often relies on Likert-type scale ques... more Research on lifestyle changes during the COVID-19 pandemic often relies on Likert-type scale question surveys. Survey participants respond to questions by selecting one of the numerically ordered choices, "Strongly Disagree"=1, "Disagree"=2, "Neutral"=3, "Agree"=4, and "Strongly Agree"=5. Analyzing Likert-type data requires statistical methods beyond approaches like linear regression. First, it is unclear if the distance between choices are truly equal. For example, are "Agree" and "Strongly Agree" more close than "Neutral" and "Agree? Second, summarizing results using traditional means makes little sense. For example, would a mean of 4.5 imply "Agree and a half"? Finally, participants tend to select more central choices and less extremes.

The article aims to explore multiple causative pathways by which obesity may worsen risk Individu... more The article aims to explore multiple causative pathways by which obesity may worsen risk Individuals with obesity face not only unique biologic vulnerabilities and structural disparities but also weight stigma that deepens health inequities in the face of a pandemic The deleterious effect of weight bias falls disproportionately on the minority and socioeconomically disadvantaged groups most affected by obesity, structural barriers to health, racism, and other forms of discrimination It therefore exacerbates inequities now painfully evident in COVID-19 cases and mortality First, further research is needed to quantify the impact of healthcare avoidance for COVID- and non-COVID-related medical needs Patients with stigmatized medical conditions like obesity are at particular risk Time from symptoms to presentation is one important measure of delayed care which has not entered published models of obesity, comorbidities, and COVID-19 Second, in words and actions, we must actively affirm t...

Nursing Clinics of North America, 2021

Through four decades of rising obesity, health policy has been mostly ineffective. Prevention pol... more Through four decades of rising obesity, health policy has been mostly ineffective. Prevention policies failed to reverse rising trends in prevalence, partly because they are often based on biased mental models about what should work to prevent obesity, rather than empiric evidence for what does work. Bias toward people living with obesity harms health, while contributing to poor access to effective care that might serve to improve it. Better public policy will come from an increased application of objective obesity science, research to fill knowledge gaps, and respect for the human dignity of people who live with obesity.

Obesity, 2021

Obesity affects 158 million youth worldwide and is associated with psychosocial comorbidity. This... more Obesity affects 158 million youth worldwide and is associated with psychosocial comorbidity. This review describes weight management options utilized by adolescents, including both self‐directed weight loss and medically supervised obesity treatment interventions, and associated psychosocial impacts. A majority of adolescents with obesity attempt to manage weight on their own, primarily through attempting weight loss, sometimes with supplement use. Approaches such as these are associated with a degree of risk, disordered eating behaviors, and further weight gain. In contrast, medically supervised multicomponent interventions are associated with improved psychosocial health, including quality of life, self‐esteem, and body image, and reduced symptoms of depression, anxiety, and eating disorders. Few studies utilizing antiobesity pharmacotherapy have reported psychosocial outcomes, and trials of bariatric surgery show some early improvements with a need for sustained psychological support following surgery. Greater access to medically supervised treatment services is required to facilitate obesity care for adolescents. Early data on psychosocial health and obesity treatment offer promising outcomes; however, larger randomized controlled trials and longer‐term data are needed. Future research should include both physiological and psychosocial outcomes to assess impact of interventions on the holistic health of adolescents with obesity.

Obesity, 2021

TO THE EDITOR: We read with great interest the special issue of Obesity devoted to the weightredu... more TO THE EDITOR: We read with great interest the special issue of Obesity devoted to the weightreduced state. This is a subject of great interest to researchers, clinicians, and people living with obesity. However, we note the unfortunate use of pejorative language in the article by Aronne et al.: “Describing the WeightReduced State: Physiology, Behavior, and Interventions.” (1) Specifically, the authors describe weight regain— a common biological phenomenon in obesity treatment— as “recidivism.” This language has no place in the clinical literature regarding obesity. Recidivism is a term defined as “the act or habit of continuing to commit crimes, and seeming unable to stop, even after being punished” (2). Having obesity, seeking treatment, and encountering weight regain after treatment have nothing to do with criminal behavior and punishment. Sogg, Grupski, and Dixon explained this in 2018 (3):

International Journal of Obesity, 2020

Nutrition & Diabetes, 2020

The dietary supplement industry has estimated sales of over 30billionintheUSandover30 billion in the US and over 30billionintheUSandover100 b... more The dietary supplement industry has estimated sales of over 30billionintheUSandover30 billion in the US and over 30billionintheUSandover100 billion globally. Many consumers believe that dietary supplements are safer and possibly more effective than drugs to treat diabetes. The sheer volume of the literature in this space makes compiling them into one review challenging, so much so that primarily narrative reviews currently exist. By applying the interactive database supplied by the Office of Dietary Supplements at the National Institutes of Health, we identified the top 100 ingredients that appeared most often in dietary supplement products. One-hundred different keyword searches using the ingredient name and the word diabetes were performed using a program developed to automatically scrape PubMed. Each search was retained in a separate Excel spreadsheet, which was then reviewed for inclusion or exclusion. The studies that met the inclusion criteria were evaluated for effect of reducing and controlling diabetes. The PubMed sc...

The American Journal of Clinical Nutrition, 2021

Background The Administrative Procedure Act of 1946 guarantees the public an opportunity to view ... more Background The Administrative Procedure Act of 1946 guarantees the public an opportunity to view and comment on the 2020 Dietary Guidelines as part of the policymaking process. In the past, public comments were submitted by postal mail or public hearings. The convenience of public comment through the Internet has generated increased comment volume, making manual analysis challenging. Objectives To apply natural language processing (NLP NLP is natural language processing.) to identify sentiment, emotion, and themes in the 2020 Dietary Guidelines public comments. Methods Written comments to the Scientific Report of the 2020 Dietary Guidelines Advisory Committee that were uploaded and visible at https://beta.regulations.gov/docket/FNS-2020-0015 were extracted using a computer program and retained for analysis. All comments were filtered, and duplicates were removed. A 2-round latent Dirichlet analysis (LDA) was used to identify 3 overarching topics as well as subtopics addressed in the...

Nutrients, 2020

We read with interest the publication by Lightowler et al [...]

Obesity, 2019

Six years after the American Medical Association recognized obesity as a complex chronic disease ... more Six years after the American Medical Association recognized obesity as a complex chronic disease (1), progress continues toward more effectively managing it as one. New research from Thomas et al. (2) in this issue of Obesity suggests once again that some of the tools that we have for obesity care are barely being used. Their study examined the use of weight management medications among more than 153,000 patients with obesity or with overweight and obesity-related comorbidities who enrolled in the Veterans Health Administration’s MOVE! program (a nationwide multicomponent weight management program) between October 2013 and September 2016. They found that 99% of these veterans who enrolled in MOVE! and were eligible for weight-management medications did not receive any prescription for an antiobesity medication within 1 year of the MOVE! initiation date.

BMC Public Health, 2019

Background A key objective of this study was to examine obesity care attitudes and behaviors of p... more Background A key objective of this study was to examine obesity care attitudes and behaviors of people with obesity (PwO) and determine independent factors associated with a self-reported sustained weight loss success outcome. Methods An online survey was conducted in 2015 among 3008 U.S. adult PwO (BMI > 30 through self-reported height and weight). Multivariate logistic models explained variation in weight loss success, defined as ≥ 10% weight loss in previous 3 years and maintained for > 1 year. Results Controlling for weight changes over time, we found significant associations between self-reported weight history and weight loss success. PwO who had personal motivation to lose weight, were willing to talk to a diabetes educator about their weight, who had their weight loss attempts recognized by a healthcare provider, and were diagnosed with “obesity” or “overweight” were more likely to report having success losing weight. Conclusions This study does not determine causality...

Obesity Reviews, 2019

Being able to draw accurate conclusions from childhood obesity trials is important to make advanc... more Being able to draw accurate conclusions from childhood obesity trials is important to make advances in reversing the obesity epidemic. However, obesity research sometimes is not conducted or reported to appropriate scientific standards. To constructively draw attention to this issue, we present 10 errors that are commonly committed, illustrate each error with examples from the childhood obesity literature, and follow with suggestions on how to avoid these errors. These errors are as follows: using self‐reported outcomes and teaching to the test; foregoing control groups and risking regression to the mean creating differences over time; changing the goal posts; ignoring clustering in studies that randomize groups of children; following the forking paths, subsetting, p‐hacking, and data dredging; basing conclusions on tests for significant differences from baseline; equating “no statistically significant difference” with “equally effective”; ignoring intervention study results in favor of observational analyses; using one‐sided testing for statistical significance; and stating that effects are clinically significant even though they are not statistically significant. We hope that compiling these errors in one article will serve as the beginning of a checklist to support fidelity in conducting, analyzing, and reporting childhood obesity research.

Journal of Medical Economics, 2019

Abstract Aims: To estimate the long-term budget impact of expanding Medicare coverage of anti-obe... more Abstract Aims: To estimate the long-term budget impact of expanding Medicare coverage of anti-obesity interventions among adults aged 65 and older in the US. Materials and methods: This study analyzed a representative sample of Medicare beneficiaries from the combined 2008–2016 National Health and Nutrition Examination Surveys. Population characteristics, cost and effectiveness of anti-obesity interventions, and the sustainability of weight loss in real-life were modeled to project the budgetary impact on gross Medicare outlay over 10 years. Hypothetical scenarios of 50% and 67% increases in intervention participation above base case were used to model moderate and extensive Medicare coverage expansion of intensive behavior therapy and pharmacotherapy. Results: For each Medicare beneficiary receiving anti-obesity treatment, we estimate Medicare savings of 6,842and6,842 and 6,842and7,155 over 10 years under moderate and extensive coverage utilization assumptions, respectively. The average cost of intervention is 1,798and1,798 and 1,798and1,886 per treated participant. Taking the entire Medicare population (treated and untreated) into consideration, the estimated 10-year budget savings per beneficiary are 308and308 and 308and339 under moderate and extensive assumptions, respectively. Sensitivity analysis of drug adherence rate and weight-loss efficacy indicated a potential variation of budget savings within 7% and 22% of the base case, respectively. Most of the projected cost savings come from lower utilization of ambulatory services and prescription drugs. Limitations: Due to the scarcity of studies on the efficacy of pharmacotherapy among older adults with obesity, the simulated weight loss and long-term maintenance effects were derived from clinical trial outcomes, in which older adults were mostly excluded from participation. The model did not include potential side-effects from anti-obesity medications and associated costs. Conclusions: This analysis suggests that expanding coverage of anti-obesity interventions to eligible individuals could generate 20–20–20–23 billion budgetary savings to Medicare over 10 years.

Preventive Medicine Reports, 2019