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Published in: International Journal of Behavioral Medicine 4/2015

01-08-2015

Application of Latent Class Analysis to Identify Behavioral Patterns of Response to Behavioral Lifestyle Interventions in Overweight and Obese Adults

Authors: Stephanie L. Fitzpatrick, Janelle W. Coughlin, Lawrence J. Appel, Crystal Tyson, Victor J. Stevens, Gerald J. Jerome, Arlene Dalcin, Phillip J. Brantley, Felicia Hill-Briggs

Published in: International Journal of Behavioral Medicine | Issue 4/2015

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Abstract

Background

Examining responders and non-responders to behavioral lifestyle interventions among overweight/obese adults with additional comorbidities may aid in refining and tailoring obesity treatment.

Purpose

The purpose of this study is to demonstrate the use of latent class analysis to identify patterns of response to behavioral lifestyle interventions based on adherence to diet and exercise recommendations.

Method

Repeated measures latent class analysis was applied to two clinical trial datasets, combination of two active interventions in the PREMIER Trial (n = 501) and phase 1 of the Weight Loss Maintenance Trial (WLM; n = 1685), to identify patterns of response to behavioral lifestyle interventions. Treatment response was based on adherence to daily recommendations for fruit/vegetable, fat, saturated fat, sodium, and exercise at baseline and 6 months.

Results

In PREMIER, three distinct latent classes emerged: responders (45.9 %), non-responders (23.6 %), and early adherers (30.5 %). Responders and Early Adherers had greater weight loss at 6 and 18 months and were more likely to meet behavioral recommendations at 18 months than Non-responders. For WLM, there were four latent classes: partial responders (16 %), non-responders (40 %), early adherers (2 %), and fruit/veggie only responders (41 %). Non-responders in WLM had significantly less weight loss at 6 months compared to that of the other three latent classes.

Conclusion

Latent class analysis is a useful method to apply to clinical trial data to identify distinct patterns of response to behavioral interventions. Overweight/ obese participants who respond to behavioral lifestyle treatment (i.e., meet behavioral recommendations) have significantly greater weight loss than that of participants who do not make behavioral changes.
Literature
2.
go back to reference Wadden TA, Webb VL, Moran CH, Bailer BA. Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation. 2012;125(9):1157–70.PubMedCentralCrossRefPubMed Wadden TA, Webb VL, Moran CH, Bailer BA. Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation. 2012;125(9):1157–70.PubMedCentralCrossRefPubMed
3.
go back to reference Kong W, Langlois MF, Kamga-Ngande C, Gagnon C, Brown C, Baillargeon JP. Predictors of success to weight-loss intervention program in individuals at high risk for type 2 diabetes. Diabetes Res Clin Pract. 2010;90(2):147–53.CrossRefPubMed Kong W, Langlois MF, Kamga-Ngande C, Gagnon C, Brown C, Baillargeon JP. Predictors of success to weight-loss intervention program in individuals at high risk for type 2 diabetes. Diabetes Res Clin Pract. 2010;90(2):147–53.CrossRefPubMed
4.
go back to reference Teixeira PJ, Going SB, Houtkooper LB, Cussler EC, Metcalfe LL, Blew RM, et al. Pretreatment predictors of attrition and successful weight management in women. Int J Obes Relat Metab Disord. 2004;28(9):1124–33.CrossRefPubMed Teixeira PJ, Going SB, Houtkooper LB, Cussler EC, Metcalfe LL, Blew RM, et al. Pretreatment predictors of attrition and successful weight management in women. Int J Obes Relat Metab Disord. 2004;28(9):1124–33.CrossRefPubMed
5.
go back to reference Collins LM, Lanza ST. Latent class and latent transition analysis: with applications in the social, behavioral, and health sciences. New Jersey: Wiley; 2010. Collins LM, Lanza ST. Latent class and latent transition analysis: with applications in the social, behavioral, and health sciences. New Jersey: Wiley; 2010.
6.
go back to reference Lanza ST, Rhoades BL. Latent class analysis: an alternative perspective on subgroup analysis in prevention and treatment. Prev Sci. 2013;14(2):157–68.PubMedCentralCrossRefPubMed Lanza ST, Rhoades BL. Latent class analysis: an alternative perspective on subgroup analysis in prevention and treatment. Prev Sci. 2013;14(2):157–68.PubMedCentralCrossRefPubMed
7.
go back to reference Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003;289(16):2083–93.PubMed Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003;289(16):2083–93.PubMed
8.
go back to reference Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Rohm Young D, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med. 2006;144(7):485–95.CrossRefPubMed Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Rohm Young D, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med. 2006;144(7):485–95.CrossRefPubMed
9.
go back to reference Svetkey LP, Stevens VJ, Brantley PJ, et al. Comparison of strategies for sustaining weight loss: the Weight Loss Maintenance randomized controlled trial. JAMA. 2008;299(10):1139–48.CrossRefPubMed Svetkey LP, Stevens VJ, Brantley PJ, et al. Comparison of strategies for sustaining weight loss: the Weight Loss Maintenance randomized controlled trial. JAMA. 2008;299(10):1139–48.CrossRefPubMed
10.
go back to reference Jones LR, Wilson CI, Wadden TA. Lifestyle modification in the treatment of obesity: an educational challenge and opportunity. Clin Pharmacol Ther. 2007;81(5):776–9.CrossRefPubMed Jones LR, Wilson CI, Wadden TA. Lifestyle modification in the treatment of obesity: an educational challenge and opportunity. Clin Pharmacol Ther. 2007;81(5):776–9.CrossRefPubMed
11.
go back to reference Funk KL, Elmer PJ, Stevens VJ, Harsha DW, Craddick SR, Lin PH, et al. PREMIER—a trial of lifestyle interventions for blood pressure control: intervention design and rationale. Health Promot Pract. 2008;9(3):271–80.CrossRefPubMed Funk KL, Elmer PJ, Stevens VJ, Harsha DW, Craddick SR, Lin PH, et al. PREMIER—a trial of lifestyle interventions for blood pressure control: intervention design and rationale. Health Promot Pract. 2008;9(3):271–80.CrossRefPubMed
12.
go back to reference Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH collaborative research group. N Engl J Med. 1997;336(16):1117–24.CrossRefPubMed Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH collaborative research group. N Engl J Med. 1997;336(16):1117–24.CrossRefPubMed
13.
go back to reference Karanja NM, Obarzanek E, Lin PH, McCullough ML, Phillips KM, Swain JF, et al. Descriptive characteristics of the dietary patterns used in the dietary approaches to stop hypertension trial. DASH collaborative research group. J Am Diet Assoc. 1999;99(8 Suppl):S19–27.CrossRefPubMed Karanja NM, Obarzanek E, Lin PH, McCullough ML, Phillips KM, Swain JF, et al. Descriptive characteristics of the dietary patterns used in the dietary approaches to stop hypertension trial. DASH collaborative research group. J Am Diet Assoc. 1999;99(8 Suppl):S19–27.CrossRefPubMed
14.
go back to reference Hollis JF, Gullion CM, Stevens VJ, et al. Weight loss during the intensive intervention phase of the Weight Loss Maintenance Trial. Am J Prev Med. 2008;35(2):118–26.PubMedCentralCrossRefPubMed Hollis JF, Gullion CM, Stevens VJ, et al. Weight loss during the intensive intervention phase of the Weight Loss Maintenance Trial. Am J Prev Med. 2008;35(2):118–26.PubMedCentralCrossRefPubMed
15.
go back to reference Blair SN, Haskell WL, Po H, Paffenbarger RS, Vranizan KM, Farquhar JW, et al. Assessment of habitual physical activity methodology by a seven-day recall in a community survey and controlled experiments. Am J Epidemiol. 1986;122:794–804. Blair SN, Haskell WL, Po H, Paffenbarger RS, Vranizan KM, Farquhar JW, et al. Assessment of habitual physical activity methodology by a seven-day recall in a community survey and controlled experiments. Am J Epidemiol. 1986;122:794–804.
16.
go back to reference Sallis JF, Haskell WL, Wood PD, Fortmann SP, Rogers T, Blair SN, et al. Physical activity assessment methodology in the five-city project. Am J Epidemiol. 1985;121(1):91–106.PubMed Sallis JF, Haskell WL, Wood PD, Fortmann SP, Rogers T, Blair SN, et al. Physical activity assessment methodology in the five-city project. Am J Epidemiol. 1985;121(1):91–106.PubMed
17.
go back to reference Harlan LC, Block G. Use of adjustment factors with a brief food frequency questionnaire to obtain nutrient values. Epidemiology. 1990;1(3):224–31.CrossRefPubMed Harlan LC, Block G. Use of adjustment factors with a brief food frequency questionnaire to obtain nutrient values. Epidemiology. 1990;1(3):224–31.CrossRefPubMed
18.
go back to reference US Department of Agriculture. The food guide pyramid. Vol Home and Garden Bulletin No. 252. Washington, D.C.: US Department of Agriculture; 1992. US Department of Agriculture. The food guide pyramid. Vol Home and Garden Bulletin No. 252. Washington, D.C.: US Department of Agriculture; 1992.
19.
20.
go back to reference Sclove L. Application of model-selection criteria to some problems in multivariate analysis. Psychometrika. 1987;52:333–43.CrossRef Sclove L. Application of model-selection criteria to some problems in multivariate analysis. Psychometrika. 1987;52:333–43.CrossRef
21.
go back to reference Nylund KL, Asparouhov T, Muthen B. Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Model: Multidiscip J. 2007;14:535–69.CrossRef Nylund KL, Asparouhov T, Muthen B. Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Model: Multidiscip J. 2007;14:535–69.CrossRef
22.
go back to reference Wang C, Brown CH, Bandeen-Roche K. Residual diagnostics for growth mixture models: examining the impact of a preventive intervention on multiple trajectories of aggressive behavior. J Am Stat Assoc. 2005;100(3):1054–76.CrossRef Wang C, Brown CH, Bandeen-Roche K. Residual diagnostics for growth mixture models: examining the impact of a preventive intervention on multiple trajectories of aggressive behavior. J Am Stat Assoc. 2005;100(3):1054–76.CrossRef
23.
go back to reference Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefPubMed Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefPubMed
24.
go back to reference Look AHEAD Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17):1566–75. Look AHEAD Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17):1566–75.
25.
go back to reference World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity, Geneva, June 3–5, 1997. 1998; Publication No. WHO/NUT/NCD/98.1. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity, Geneva, June 3–5, 1997. 1998; Publication No. WHO/NUT/NCD/98.1.
26.
go back to reference Subar AF, Thompson FE, Kipnis V, Midthune D, Hurwitz P, McNutt S, et al. Comparative validation of the Block, Willett, and National Cancer Institute Food Frequency Questionnaires. Am J Epidemiol. 2001;154(12):1089–99.CrossRefPubMed Subar AF, Thompson FE, Kipnis V, Midthune D, Hurwitz P, McNutt S, et al. Comparative validation of the Block, Willett, and National Cancer Institute Food Frequency Questionnaires. Am J Epidemiol. 2001;154(12):1089–99.CrossRefPubMed
27.
go back to reference Sloane R, Clutter Snyder D, Demark-Wahnefried W, Lobach D, Kraus WE. Comparing the 7-day PAR with a triaxial accelerometer for measuring time in exercise. Med Sci Sports Exerc. 2009;41(6):1334–40.PubMedCentralCrossRefPubMed Sloane R, Clutter Snyder D, Demark-Wahnefried W, Lobach D, Kraus WE. Comparing the 7-day PAR with a triaxial accelerometer for measuring time in exercise. Med Sci Sports Exerc. 2009;41(6):1334–40.PubMedCentralCrossRefPubMed
28.
go back to reference de Vries H, Van’t Riet J, Spigt M, Metsemakers J, van den Akker M, Vermunt JK, et al. Clusters of lifestyle behaviors: results from the Dutch SMILE study. Prev Med. 2008;46(3):203–8.CrossRefPubMed de Vries H, Van’t Riet J, Spigt M, Metsemakers J, van den Akker M, Vermunt JK, et al. Clusters of lifestyle behaviors: results from the Dutch SMILE study. Prev Med. 2008;46(3):203–8.CrossRefPubMed
29.
go back to reference BeLue R, Lanza ST, Figaro MK. Lifestyle therapy changes and hypercholesterolemia: Identifying risk groups in a community sample of Blacks and Whites. Ethn Dis. 2009;19(2):142–7.PubMedCentralPubMed BeLue R, Lanza ST, Figaro MK. Lifestyle therapy changes and hypercholesterolemia: Identifying risk groups in a community sample of Blacks and Whites. Ethn Dis. 2009;19(2):142–7.PubMedCentralPubMed
30.
go back to reference Ogden LG, Stroebele N, Wyatt HR, Catenacci VA, Peters JC, Stuht J, et al. Cluster analysis of the national weight control registry to identify distinct subgroups maintaining successful weight loss. Obesity (Silver Spring). 2012;20(10):2039–47.CrossRef Ogden LG, Stroebele N, Wyatt HR, Catenacci VA, Peters JC, Stuht J, et al. Cluster analysis of the national weight control registry to identify distinct subgroups maintaining successful weight loss. Obesity (Silver Spring). 2012;20(10):2039–47.CrossRef
31.
go back to reference Trivedi RB, Ayotte BJ, Thorpe CT, Edelman D, Bosworth HB. Is there a nonadherent subtype of hypertensive patient? A latent class analysis approach. Patient Prefer Adherence. 2010;4:255–62.PubMedCentralCrossRefPubMed Trivedi RB, Ayotte BJ, Thorpe CT, Edelman D, Bosworth HB. Is there a nonadherent subtype of hypertensive patient? A latent class analysis approach. Patient Prefer Adherence. 2010;4:255–62.PubMedCentralCrossRefPubMed
32.
go back to reference Lanza ST, Collins LM. A mixture model of discontinuous development in heavy drinking from ages 18 to 30: the role of college enrollment. J Stud Alcohol. 2006;67(4):552–61.CrossRefPubMed Lanza ST, Collins LM. A mixture model of discontinuous development in heavy drinking from ages 18 to 30: the role of college enrollment. J Stud Alcohol. 2006;67(4):552–61.CrossRefPubMed
33.
go back to reference Espeland MA, Bray GA, Neiberg R, et al. Describing patterns of weight changes using principal components analysis: results from the action for health in diabetes (Look AHEAD) research group. Ann Epidemiol. 2009;19(10):701–10.PubMedCentralCrossRefPubMed Espeland MA, Bray GA, Neiberg R, et al. Describing patterns of weight changes using principal components analysis: results from the action for health in diabetes (Look AHEAD) research group. Ann Epidemiol. 2009;19(10):701–10.PubMedCentralCrossRefPubMed
34.
go back to reference Neiberg RH, Wing RR, Bray GA, et al. Patterns of weight change associated with long-term weight change and cardiovascular disease risk factors in the Look AHEAD study. Obesity (Silver Spring). 2012;20(10):2048–56.CrossRef Neiberg RH, Wing RR, Bray GA, et al. Patterns of weight change associated with long-term weight change and cardiovascular disease risk factors in the Look AHEAD study. Obesity (Silver Spring). 2012;20(10):2048–56.CrossRef
35.
go back to reference Vermunt JK, Magidson J. Latent class cluster analysis. In: Hagenaars JA, McCutcheon AL, eds. Applied latent class analysis. Cambridge University Press:; 2002:89–106. Vermunt JK, Magidson J. Latent class cluster analysis. In: Hagenaars JA, McCutcheon AL, eds. Applied latent class analysis. Cambridge University Press:; 2002:89–106.
36.
go back to reference Fitzpatrick SL, Lai BS, Brancati FL, Golden SH, Hill-Briggs F. Metabolic syndrome risk profiles among African American adolescents: National Health and Nutrition Examination Survey, 2003–2010. Diabetes Care. 2013;36(2):436–42.PubMedCentralCrossRefPubMed Fitzpatrick SL, Lai BS, Brancati FL, Golden SH, Hill-Briggs F. Metabolic syndrome risk profiles among African American adolescents: National Health and Nutrition Examination Survey, 2003–2010. Diabetes Care. 2013;36(2):436–42.PubMedCentralCrossRefPubMed
37.
go back to reference Lei H, Nahum-Shani I, Lynch K, Oslin D, Murphy SA. A “SMART” design for building individualized treatment sequences. Annu Rev Clin Psychol. 2012;8:21–48.CrossRefPubMed Lei H, Nahum-Shani I, Lynch K, Oslin D, Murphy SA. A “SMART” design for building individualized treatment sequences. Annu Rev Clin Psychol. 2012;8:21–48.CrossRefPubMed
38.
go back to reference Almirall D, Nahum-Shani I, Sherwood NE, Murphy SA. Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research. Translational Behavioral Medicine. Published online: 06 May 2014. Almirall D, Nahum-Shani I, Sherwood NE, Murphy SA. Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research. Translational Behavioral Medicine. Published online: 06 May 2014.
Metadata
Title
Application of Latent Class Analysis to Identify Behavioral Patterns of Response to Behavioral Lifestyle Interventions in Overweight and Obese Adults
Authors
Stephanie L. Fitzpatrick
Janelle W. Coughlin
Lawrence J. Appel
Crystal Tyson
Victor J. Stevens
Gerald J. Jerome
Arlene Dalcin
Phillip J. Brantley
Felicia Hill-Briggs
Publication date
01-08-2015
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 4/2015
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-014-9446-y

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