Social-ecological predictors of weight loss in a sample of individuals with traumatic brain injury enrolled in a 12-month healthy lifestyle program



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Weight gain post traumatic brain injury (TBI) is a major concern. The purpose of this study was to employ secondary data analysis to examine the relationship of social-ecological factors on weight loss success in a sample of individuals with TBI who completed a 12-month weight-loss program called the Diabetes Prevention Program Group Lifestyle Balance (DPP-GLB) modified for people with TBI (GLB-TBI). Participants in the primary study were eligible if they (a) were between the ages of 18-64 years, (b) were greater than six months post TBI, (c) had a moderate or severe TBI, and (d) had a body mass index (BMI) greater to or equal to 25 kg/m2. Participants (n = 57) were randomized to either the GLB-TBI (n = 24) or attention control condition (n = 23). Secondary data included body weight (measured on a wheel-chair accessible scale), self-efficacy (measured by the General Self-Efficacy Scale [GSE] and Self-Rated Abilities for Health Practice Scale [SRAHP]), social support (measured by the Social Support for Diet and Exercise Behaviors Scale), and neighborhood walkability (measured by the Walk Score® and Neighborhood Environment Walkability Scale [NEWS]). Participants randomized to the GLB-TBI group lost an average of -15.5 ± 16.4 lbs. over the 12-month program. Sixteen of the 24 participants (66.7%) lost more than 5% of their body weight (responders). Regression analysis did not show statically significant correlations between social-ecological variables and weight loss at 12-months for participants in the GLB-TBI group. For the GLB-TBI group, SRAHP total score and subscales of Nutrition, Well-being, and Exercise changed significantly over time with effect sizes ranging from 0.48 to 0.66. Finally, comparisons of responders to non-responders showed that responders were younger, had more years post injury, had higher income, had higher education, and had less comorbid conditions. The SRAHP subscale of Health Practices was significantly higher at baseline for people who lost 5% of their body weight (p = .023) and the subscale of Nutrition was nearing significance (p = 0.058). In conclusion, results suggest that self-efficacy may be an important target for future interventions to enhance weight loss for participants with in the GLB-TBI.



Traumatic Brain Injury