User:Chg1985/Aspire-for-life Weight Management

Aspire for Life - Aspire for Life is an Internet-based programme designed to promote weight loss with the modification of dietary and physical activity behaviour, developed by the New Zealand Institute for Plant & Food Research.

=History of Aspire=

The principles of the Aspire nutrition plan are based on foods that release sustained energy (i.e. with a low glycemic load). Plant & Food Research, within their ‘Lifestyle Foods’ contract with the NZ Foundation for Research Science and Technology, commissioned the University of Otago to conduct a random control trial in 2004 to compare the weight loss effects of a low glycemic diet plus exercise with more traditional low fat diet plus exercise. Over the eighteen month study period both groups lost a similar amount of weight, approximately 10% of body weight on average. Attrition rates were however significantly lower for the low glycemic load plan than the low fat group, 25% and 54% respectively. Given that a higher number of participants in the low glycemic group remained in the study, this approach was considered to be an option that was both acceptable and effective [3].

These research findings formed the basis of Aspire’s pilot website designed to provide information and guidance on sustained energy nutrition and moderate physical activity. In 2007, six months of research was conducted on the website in 104 individuals with a body mass index, BMI of >28. Of the 70 participants who remained in the study, 75% lost weight and 60% reported increased physical activity. The group also reported an increase in fruit, vegetable and legume consumption and a reduction in self-rated hunger [4].

In 2008 the commercial website was publicly launched under the trademark Aspire Diet. In early 2009 the programme underwent a name change to become Aspire for Life.

=How the programme works=

Aspire for Life is an online twenty-four week weight management programme broken into two, twelve week segments. Registered users access a clinically proven, personalized food plan, supported by credible nutrition and physical activity information and self-monitoring tools to help set goals and measure progress. Users also receive individual feedback, advice and motivation by specialists in nutrition, physical activity, behaviour change and recipe design.

Central to the programme is the food plan based on slow digesting carbohydrates that can prolong satiety, improve energy levels, and/or reduce the risk of certain chronic diseases such as heart disease. Slow digesting carbohydrates, also called low Glycemic Load (GL) foods, include whole grain breads and cereals, legumes, low fat dairy products, and most fruits and vegetables. When broken down in the body, these foods cause a slower rise in blood glucose levels and insulin response. This mitigation in blood glucose response can have a direct effect on physical hunger among other benefits. Four years of New Zealand scientific research indicate that a diet based on slow digesting carbohydrates facilitates a weight loss comparable to a conventional low fat diet, however provides greater satiety/less hunger than the conventional plan [1].

The Aspire programme adjusts the food plan for each user based on their individual energy needs; the Mifflin St. Jeor equation calculates the individual’s energy expenditure using the individual’s height, weight, sex, age and amount of physical activity. An energy deficit is factored in to facilitate a gradual, steady weight loss of 0.5 to 1 kilogram per week for overweight and obese individuals.

Developed in New Zealand, the Aspire website is commercially accessible around the world (in English). Aspire is a project of the New Zealand Institute for Plant & Food Research with input from various partner organisations, in the food and physical activity sectors.

=Purpose and benefits=

The Aspire programme aims to facilitate sustainable changes in eating and exercise habits that promote weight loss and well-being. Weight loss to improve health, physical appearance and/or self esteem are the most common motives. However, the low glycemic nutrition and moderate-intensity physical activity plan endorsed by Aspire may also reduce the risk or improve the management of conditions like heart disease, type 2 diabetes and some forms of cancer by modifying risk factors such as blood pressure, lipid profiles and glucose tolerance [2].

=Research on Internet tools for health behaviour=

Positive but moderate benefits resulting from the use of internet tools have been reported in a number of clinical studies and reviews for health behaviours including dietary changes, physical activity and smoking cessation [5, 6].

One of the reviews examined randomized controlled trials investigating the efficacy of Internet-based programmes designed for adults with weight issues [7]. Of the six studies selected for review, half were commercial websites. The strategies employed bear similarities to those used in Aspire: altering energy balance through dietary modification and/or physical activity, using cognitive-behavioural strategies such as goal setting and self-monitoring, and providing individualized support and feedback. The review concluded that Internet based programmes with such elements are capable of facilitating successful behaviour change and weight loss. While internet programmes taking this approach result in greater weight loss than websites offering information only or automated feedback [7, 8], face to face programmes have generally been shown to result in larger effect sizes, as well as higher compliance and participant satisfaction [7, 9]. Internet interventions however are a more cost effective way to access a larger number of people, and offer their own unique advantages [6, 7].

=Advantages and disadvantages=

Advantages of the Aspire programme include its research based approach, convenience, anonymity, and ability to reach large numbers of people with individualized information. As indicated previously, Aspire is a research backed program [1, 4] that contains the elements of an effective Internet weight management program: a structured approach, cognitive-behavioural strategies and personalized feedback[7]. Aspire provides 24 hour-a-day access to information and support services which participants of internet health tools especially favour [6]. This may also provide added benefits for people with high time constraints, increased travel demands and/or limited access to services [7, 10]. The non-intrusive nature and anonymity of the Internet as a medium is highly attractive for many participants, and they especially value the absence of social cues such as appearance or weight and other perceived disadvantages of face-to-face programmes [6]. Lastly, Web based programmes provide a cost-effective medium to reach large numbers of people with individualized information. Tailored information, such as Aspire’s personalized food plan, can have a beneficial influence on a person’s health knowledge and behaviours by providing a more relevant experience [6, 7].

Aspire programme presents some disadvantages for people who lack Internet access or a reasonable ability to navigate the web, prefer “face to face” interaction for support, or have a tendency towards sedentary behaviour. People must have regular access to the Internet to utilize Aspire, therefore the program may exclude the 39.5% of New Zealanders who do not yet have home access to the Internet [11]. A usability study of a pilot version of the Aspire website indicated participants struggled to find key information on the site and that lack of search functions or a site map reduced user efficiency [12]. They also found long pages with too much text difficult to scan [12]. In developing the current www.aspireforlife.com website, a more “user-friendly” website has been designed with shorter navigation paths, a search function on recipes, and a clearer classification of topics. The web pages have also been made more readable with highlighted text and bullet points. Some individuals dislike the lack of face-to-face social contact with professionals and other members of Internet programs and have directly specified a preference for face-to-face groups [6]. Finally Internet-based weight loss interventions have been critiqued for their sedentary nature, however it is important to note that individual consultations, book reading and support groups are also sedentary activities [7].

=References=

1.The New Zealand Institute for Crop and Food Research and The University of Otago, Effect of diets differing in glycaemic load on weight loss. 2004-2007.

2.Thomas, D., E. Elliot, and L. Baur, Low glycaemic index or low glycaemic load diets for overweight and obesity. Cochrane Database of Systematic Reviews, 2007(3).

3.The New Zealand Institute for Crop&Food Research and The University of Otago, Effect of diets differing in glycaemic load on weight loss. 2004-2007.

4.The New Zealand Institute for Crop & Food Research and The University of Otago, Aspire web-based weight reduction programme Pilot Study. 2006-2007.

5.Bessell, T.L., et al., Do Internet interventions for consumers cause more harm than good? A systematic review. Health Expectations, 2002. 5(1).

6.US Department of Health and Human Services, Expanding the Reach and Impact of Consumer e-Health Tools, in Health Communication Activities, O.o.D.P.a.H. Promotion, Editor. 2006: USA.

7.Saperstein, S., N. Atkinson, and R. Gold, The impact of Internet use for weight loss. Obesity Reviews, 2007. 8: p. 459–465.

8.Tate, D., R. Wing, and R. Winnett, Using Internet technology to deliver a behavioral weight loss program. Journal of the American Medical Association 2001. 285: p. 1172-7.

9.Harvey-Berino, J., S.J. Pintauro, and E.C. Gold, The Feasibility of Using Internet Support for the Maintenance of Weight Loss. Behav Modif, 2002. 26(1): p. 103-116.

10.Womble, L.G., Wadden, T.A., Mcguckin, B.G., Sargent, S.L., Rothman, R.A. & Krauthamer-Ewing, E.S. (2004) A randomized controlled trial of a commercial internet weight loss program. Obesity Research 2004. 12: p. 1011-1018.

11.Statistics New Zealand (2007). Quickstats National Highlightes – 2006 Census. Revised 9 August 2007. http://www.stats.govt.nz/census/2006-census-data/national-highlights/2006-census-quickstats-national-highlights-revised.htm?page=para011Master (Last accessed 16 February 2009).

12.Wilson P. (2007). Usability testing of the aspirediet.com website. Crop and Food Research Confidential Report, November.