Rona Levy | University of Washington (original) (raw)

Papers by Rona Levy

Translational behavioral medicine, Mar 19, 2021

BackgroundIndividuals receiving behavioral weight loss treatment frequently fail to adhere to pre... more BackgroundIndividuals receiving behavioral weight loss treatment frequently fail to adhere to prescribed dietary and self-monitoring instructions, resulting in weight loss clinicians often needing to assess and intervene in these important weight control behaviors. A significant obstacle to improving adherence is that clinicians and clients sometimes disagree on the degree to which clients are actually adherent. However, prior research has not examined how clinicians and clients differ in their perceptions of client adherence to weight control behaviors, nor the implications for treatment outcomes.PurposeIn the context of a 6-month weight-loss treatment, we examined differences between participants and clinicians when rating adherence to weight control behaviors (dietary self-monitoring; limiting calorie intake) and evaluated the hypothesis that rating one’s own adherence more highly than one’s clinician would predict less weight loss during treatment.MethodsUsing clinician and participant-reported measures of self-monitoring and calorie intake adherence, each assessed using a single item with a 7- or 8-point scale, we characterized discrepancies between participant and clinician adherence and examined associations with percent weight change over 6 months using linear mixed-effects models.ResultsResults indicated that ratings of adherence were higher when reported by participants and supported the hypothesis that participants who provided higher adherence ratings relative to their clinicians lost less weight during treatment (p < 0.001).ConclusionsThese findings suggest that participants in weight loss treatment frequently appraise their own adherence more highly than their clinicians and that participants who do so to a greater degree tend to lose less weight.

Gastroenterology, Oct 1, 2001

Annals of Behavioral Medicine, Aug 20, 2021

BackgroundState-of-the-art behavioral weight loss treatment (SBT) can lead to clinically meaningf... more BackgroundState-of-the-art behavioral weight loss treatment (SBT) can lead to clinically meaningful weight loss, but only 30–60% achieve this goal. Developing adaptive interventions that change based on individual progress could increase the number of people who benefit.PurposeConduct a Sequential Multiple Assignment Randomized Trial (SMART) to determine the optimal time to identify SBT suboptimal responders and whether it is better to switch to portion-controlled meals (PCM) or acceptance-based treatment (ABT).MethodThe BestFIT trial enrolled 468 adults with obesity who started SBT and were randomized to treatment response assessment at Session 3 (Early TRA) or 7 (Late TRA). Suboptimal responders were re-randomized to PCM or ABT. Responders continued SBT. Primary outcomes were weight change at 6 and 18 months.ResultsPCM participants lost more weight at 6 months (−18.4 lbs, 95% CI −20.5, −16.2) than ABT participants (−15.7 lbs, 95% CI: −18.0, −13.4), but this difference was not statistically significant (−2.7 lbs, 95% CI: −5.8, 0.5, p = .09). PCM and ABT participant 18 month weight loss did not differ. Early and Late TRA participants had similar weight losses (p = .96), however, Early TRA PCM participants lost more weight than Late TRA PCM participants (p = .03).ConclusionsResults suggest adaptive intervention sequences that warrant further research (e.g., identify suboptimal responders at Session 3, use PCMs as second-stage treatment). Utilizing the SMART methodology to develop an adaptive weight loss intervention that would outperform gold standard SBT in a randomized controlled trial is an important next step, but may require additional optimization work.Clinical Trial informationClinicalTrials.gov identifier; {"type":"clinical-trial","attrs":{"text":"NCT02368002","term_id":"NCT02368002"}}NCT02368002

Gastroenterology, Apr 1, 2016

Health Education & Behavior, Sep 14, 2018

Background: Behavioral interventions to prevent pediatric obesity have shown inconsistent results... more Background: Behavioral interventions to prevent pediatric obesity have shown inconsistent results across the field. Studying what happens within the 'black box' of these interventions and how differences in implementation lead to different outcomes will help researchers develop more effective interventions. Aims: To compare the implementation of three features of a phone-based intervention for parents (time spent discussing weight-related behaviors, behavior change techniques present in sessions, and intervention activities implemented by parents between sessions) with study outcomes. Methods: A random selection of 100 parent-child dyads in the intervention arm of a phone-based obesity prevention trial were included in this analysis. Sessions were coded for overall session length, length of time spent discussing specific weight-related behaviors, behavior change techniques used during sessions, and intervention-recommended activities implemented by parents between sessions (e.g., parentreported implementation of behavioral practice/rehearsal between sessions). The primary study outcome, prevention of unhealthy increase in child BMI percentile, was measured at baseline and 12 months. Results: Overall session length was associated with decreases in child BMI percentile (b =-0.02, p = 0.01). There was no association between number of behavior change techniques used in sessions and decreases in child BMI percentile (b =-0.29, p = 0.27). The number of activities parents reported implementing between sessions was associated with decreases in child BMI percentile (b =-1.25, p = 0.02). Discussion: To improve future interventions, greater attention should be paid to the intended and delivered session length and efforts should be made to facilitate parents' implementation of intervention-recommended activities between sessions.

Contemporary Clinical Trials, Sep 1, 2013

Pediatric primary care is an important setting in which to address obesity prevention, yet relati... more Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/ Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a Contact Control condition that focuses on safety and injury prevention. The HHHK 5-10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The Contact Control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5-10 trial.

De Gruyter eBooks, Dec 31, 1996

The functional gastrointestinal disorders (FGID) are the most frequent conditions seen in gastroe... more The functional gastrointestinal disorders (FGID) are the most frequent conditions seen in gastroenterology practice and comprise a major portion of primary care. Psychosocial factors are important in these disorders with regard to: (1) their eVects on gut physiology; (2) their modulation of the symptom experience; (3) their influence on illness behavior; (4) their impact on outcome; and (5) the choice of the therapeutic approach. This paper provides a review and consensus of the existing literature by gastroenterologists, psychiatrists, psychologists, physiologists, and health services investigators. Evidence is provided to support the biopsychosocial model as a basis for understanding and treating these disorders, and epidemiological and clinical information on the relations of psychosocial factors to gut physiology, symptom presentation, health behavior, and outcome is oVered. Features of motility, personality, abuse history, health concerns, and treatment-seeking diVer between patients with FGID and healthy controls, but they are not specific to FGID. They occur in other patients with chronic medical conditions and/or psychiatric disorders. Review of treatment trials indicates clear support for psychotherapeutic treatments, especially in the long term, as well as some evidence for the benefit of antidepressants in FGID, even in the absence of improvements in mood.

Gastroenterology, May 1, 2020

modulation, conduction and synaptic transmission. Relative gene expression was calculated using t... more modulation, conduction and synaptic transmission. Relative gene expression was calculated using the 2-D DCt method and regression analyses were conducted to identify associations between gene expression and pain burden using a restrictive p-value of £0.001. Demographic and clinical characteristics were recorded. Results: We studied 34 subjects with PDS (62% female; mean age 15 years), 7 with EPS (57% female; mean age 13.5 years), 25 with both PDS and EPS (PDS+EPS); 76% female; mean age 13.4 years). 13 children with eosinophilic esophagitis (EoE) served as a no-pain control group; 8% female; mean age 12.7 years) The pain groups (PDS, EPS and PDS+EPS) were similar with respect to age, gender, pain burden and severity scores, antidepressant/antianxiolytic and PPI use. Similarly, there were no statistically significant differences in the number of antral or duodenal eosinophil counts, presence of intraepithelial, submucosal or muscularis mucosae eosinophils in either the antrum and duodenum. Pain burden and severity scores did not correlate with the antral or duodenal eosinophil counts. mRNA expression data were available on 49 subjects. One candidate gene, Prostaglandin E Synthase 3 (PTGES3) was significantly differentially expressed in the antrum (r^2-change = 0.204, F-change = 11.506, p = 0.001) in relation to the pain burden. On regression analysis, higher PTGES3 expression was predictive of increased pain burden (r = 0.451). Conclusions: PTGES3, an enzyme that converts prostaglandin endoperoxide H2 (PGH2) to prostaglandin E2 (PGE2) is significantly differentially expressed in children with FD and a higher pain burden. This candidate gene may have potential as a novel therapeutic target for FD.

The American Journal of Gastroenterology, Oct 1, 2012

Purpose: Th e obesity epidemic aff ects both pediatric and adult populations. Previous studies ha... more Purpose: Th e obesity epidemic aff ects both pediatric and adult populations. Previous studies have shown obesity and disordered eating behaviors to be linked to common functional gastrointestinal disorders in children. However, there has been limited research on overweight pre-adolescent children and GI disorders. Aim: To evaluate eating behaviors and quality of life in pre-adolescent children at risk for obesity with and without abdominal pain (AP). Methods: Children at risk for obesity (70th-95th percentile of BMI for age and gender; n=297) between the ages of 5 and 11 yrs were recruited to participate in a randomized, controlled obesity prevention study. At the baseline visit, children and their parents completed the following validated scales: Child feeding practices-Child feeding questionnaire, Child Eating Behavior Questionnaire (CEBQ, Disordered Eating Scale), Pediatric Quality of LifePedsQL Short Form (ages 5-8, Parent Report form), Parent Depression StatusPatient Health Questionnaire (PHQ-9) and Rome III questions on abdominal pain and bowel function. Univariate and multivariable statistics were used to evaluate the association between MS and pelvic fl oor dysfunction. Th e criterion for signifi cance (alpha) was set at 0.050, 2-tailed. Results: Children reported to have AP > 2/mos (n=73) were compared to children having AP < 1/mos (n=224). In univariate analyses (Table 1), age and BMI did not diff er between groups, but AP was more prevalent in females. Th e Emotional Overeating scale on the CEBQ and the PHQ-9 Parent Depression Status were statistically diff erent between groups. AP was also associated with decreased Emotional and Social domain scores on the PedsQL. In multivariable logistic regression female gender (OR 2.18; 95% CI 1.20-3.97; P=0.011), CEBQ Emotional Overeating (OR 2.28; 95% CI 1.37-3.81; P=0.002), and the PHQ-9 Parental Depression score (OR 1.23; 95% CI 1.12-1.35; P<0.001) were associated with more frequent AP. Higher scores on the CFQ Concern about child’s weight scale were associated with less frequent AP (OR .72; 95% CI 0.53-0.95; P=0.02). Conclusion: In a large group of pre-adolescent children at risk for obesity, more frequent abdominal pain was associated with female gender, emotional overeating, and parental depression. Increased parental concern with their child’s weight was associated with less frequent abdominal pain. 1928

Research in Nursing & Health, Feb 1, 1996

Gastroenterology Nursing, Nov 1, 1995

Irrtable Bowel Syndrome (IBS) is a common problem affecting a sigificant portion of the U.S. popu... more Irrtable Bowel Syndrome (IBS) is a common problem affecting a sigificant portion of the U.S. population. Nurses are involved directly in the planning and implementing of theraopeutic interventions for this patient population. Using a Human Response Model, the authors of this article review intervention studies for IBS. This model provides a context for integration of Person (vulnaribility) and Environmenntal (risk) factors that may modfy the patient's response to a given therapeutic regimen. Human responses are categorized as Physiological, Pathophysiological, and Behavioral/Experimental. Interdisciplinary therapeutic strategies include motiity manipulations via pharmacological agents, dietary modifications, and self-care enhancement. Areas for nursing research are described.

Journal of Advanced Nursing, Dec 13, 2022

AimsTo understand the experiences and needs of symptom management among individuals with irritabl... more AimsTo understand the experiences and needs of symptom management among individuals with irritable bowel syndrome and concurrent symptoms of anxiety and/or depression.DesignThis study used a qualitative descriptive research design.MethodsIndividuals with a diagnosis of irritable bowel syndrome and concurrent symptoms of anxiety and/or depression participated were recruited through an online ResearchMatch and a listserv. Semi‐structured interviews focused on symptoms and experiences with symptom management interventions conducted from June to August 2020. Interviews were transcribed and data were analysed based on thematic analysis.ResultsTwelve individuals participated in this study; all reported current irritable bowel syndrome and anxiety/depression symptoms. The data analysis cumulated with three themes related to symptom management: (a) irritable bowel syndrome negatively impacts physical and mental well‐being; (b) a trial and error approach to symptom management; and (c) challenges with healthcare professionals supporting symptom management including negative interactions with healthcare professionals and lack of nutritional expertize and support.ConclusionThere is a need for individualized approaches which consider patients' current symptoms of anxiety and depression, previous experiences with the trial‐and‐error process and consideration for intervention delivery methods.ImpactThere is a limited qualitative research focusing on the experiences of individuals with irritable bowel syndrome and concurrent symptoms of anxiety and/or depression. This research highlights the need for individualized approaches to enhance symptom management that acknowledges patients' psychological state and past negative experiences with providers and prior dietary regimens.

Gastroenterology, Apr 1, 2000

Health behavior and policy review, Jul 1, 2017

Background: There is value in having parents choose which behaviors to address in obesity interve... more Background: There is value in having parents choose which behaviors to address in obesity interventions, but it is unknown whether they choose behaviors that will effectively impact healthy growth. This study assessed whether child behaviors or parent intention to change behaviors were associated with behaviors parents chose to discuss. Methods: Parent intention to change specific behaviors and time spent discussing behaviors was coded during intervention sessions. Results: Child activity, screen-time, energy intake, breakfast, and family meals were associated with time spent discussing these behaviors. Fewer associations were seen between parent intention and time spent discussing these behaviors.

Pediatric obesity, Mar 14, 2019

SummaryBackground:Pediatric primary care is an important setting for addressing obesity preventio... more SummaryBackground:Pediatric primary care is an important setting for addressing obesity prevention.Objective:The Healthy Homes/Healthy Kids 5‐10 randomized controlled trial evaluated the efficacy of an obesity prevention intervention integrating pediatric primary care provider counseling and parent‐targeted phone coaching.Methods:Children aged 5 to 10 years with a BMI between the 70th and 95th percentile and their parents were recruited from pediatric primary care clinics. Participants received well‐child visit provider counseling about obesity and safety/injury prevention and were then randomized to a 14‐session phone‐based obesity prevention (OP; n = 212) or safety and injury prevention contact control (CC; n = 209) intervention. The primary outcome was 12 and 24‐month child BMI percentile.Results:There was no overall significant treatment effect on child BMI percentile. Caloric intake was significantly lower among OP compared with CC participants at 12 months (P < .005). In planned subgroup analyses, OP condition girls had significantly lower BMI percentile (P < .05) and BMI z‐score (P < .02) at 12 and 24 months relative to CC girls and were less likely to be overweight (38.0% vs 53.0%, P < .01) or (obese 3.4% vs 8.8%, P < .10) at follow‐up.Conclusions and Relevance:An obesity prevention intervention integrating brief provider counseling and parent‐targeted phone counseling did not impact 12 and 24‐month BMI status overall but did have a significant impact on BMI in girls.

Journal of Clinical Gastroenterology, Mar 12, 2021

Goals:The goal of this study was to describe the influence of the COVID-19 pandemic on ability to... more Goals:The goal of this study was to describe the influence of the COVID-19 pandemic on ability to engage in activities and the influence on psychological distress and gastrointestinal symptoms among individuals with irritable bowel syndrome (IBS) and comorbid anxiety and/or depression.Background:Individuals with IBS and comorbid anxiety and/or depression report increased symptoms and decreased quality of life compared to individuals with IBS alone. The current COVID-19 pandemic has the potential to further influence symptoms among individuals with IBS and comorbid anxiety and/or depressionStudy:Individuals who met the Rome-IV IBS criteria and reported mild to severe anxiety and/or depression were included. Participants completed an online survey with questions about anxiety, depression, impact of COVID on activities and symptoms, and demographics.Results:Fifty-five individuals participated in the study. The COVID-19 pandemic most commonly influenced their ability to spend time with friends and family, shop for certain types of food, and access healthcare. Participants also reported increased stress (92%), anxiety (81%), and depressive symptoms (67%). Finally, around half the sample reported increases in abdominal pain (48%), diarrhea (45%), or constipation (44%).Conclusions:The COVID-19 pandemic is related to self-reported increases in psychological distress and gastrointestinal symptoms among individuals with IBS and comorbid anxiety and/or depression. Additional research is needed to intervene on these symptoms.

The American Journal of Gastroenterology, Apr 1, 2010

OBJECTIVES-Unexplained abdominal pain in children has been shown to be related to parental respon... more OBJECTIVES-Unexplained abdominal pain in children has been shown to be related to parental responses to symptoms. This randomized controlled trial tested the efficacy of an intervention designed to improve outcomes in idiopathic childhood abdominal pain by altering parental responses to pain and children's ways of coping and thinking about their symptoms.

Children

While much has been written about the relationship between only child status and parents’ behavio... more While much has been written about the relationship between only child status and parents’ behavior toward children, and consequent personality and intelligence, little is known about the relationship between only child status, parental response to illness, and subsequent child illness behavior. In this study, 227 mothers of 342 children completed measures designed to assess: (a) their children’s school attendance, (b) their own psychological status, and (c) their own responses to their children’s expressions of stomach pain. Parents of only children were more likely to minimize their children’s gastrointestinal symptoms than were parents of children with at least one sibling. In addition, only children were less likely to miss school. Parental protectiveness did not differ as a function of only child status. These findings are somewhat discrepant with commonly held beliefs about parents’ patterns of responding to only children.

BACKGROUND Despite pharmacological treatment, individuals with inflammatory bowel disease (IBD) e... more BACKGROUND Despite pharmacological treatment, individuals with inflammatory bowel disease (IBD) experience a variety of symptoms, including abdominal pain, fatigue, anxiety, and depression. Few nonmedical self-management interventions are available for people with IBD. A validated comprehensive self-management (CSM) intervention is effective for patients with irritable bowel syndrome who can have symptoms similar to those of individuals with IBD. We created a modified CSM intervention tailored to individuals with IBD (CSM-IBD). The CSM-IBD is an 8-session program delivered over 8-12 weeks with check-ins with a registered nurse. OBJECTIVE The primary objective of this pilot study is to determine the feasibility and acceptability of study procedures and the CSM-IBD intervention and to evaluate preliminary efficacy on quality of life and daily symptoms for a future randomized controlled trial. Additionally, we will examine the association of socioecological, clinical, and biological fa...