So now I want to walk through an actual example of a randomized controlled trial where individuals received a very brief tailored intervention, where there was a psychoeducation component, giving people information surrounding how to optimize their healthy diet and working on some educational and motivational factors. So this means that a primary theory of health behavior change, the stages of change model was employed to help motivate people towards initiating change. Changing one's health behaviors is very difficult. We know this. So this model actually assisted people in enabling them toward change by using this stages of change model and working with people in what's identified as the pre-contemplation and contemplation preparation stage. What happens is, a pre-contemplation people don't want to change. That's just weird, this is what I want to be doing, that's it. The wheel works by doing this motivational type of intervention and helping people get to ploy, "You know what, there's actually going to be an benefit towards me changing." It initiates or motivates desire to change and then equips people with the ability to do so. It gives them the tools, gives them the tools to change their own environment, for example, so that change becomes a lot easier. What they found here is that at baseline, the two groups were motivational, interviewing, basically stages of change model followed by actual intervention. At baseline, the groups did not differ. This is something you always do in controlled trials. You want to make sure that at baseline before employing any type of intervention, everything's equal. So we've found baseline, everything's equal. But at post treatment, we can see some actual improvements that the intervention was much better in helping people approximate or boost their food intake, boost their vegetable intake and so on. That their total daily intake of fruits and vegetables increased and as did their knowledge. So it was actually helpful, like helping people through this motivational piece was a boost, right? Yeah. I also want to review for you briefly the LOOK-Ahead trial. This trial is an enormous multi-site trial and it's ongoing. It's an intensive lifestyle intervention study. That means that it actually employs an entire toolkit of interventions that starts with here as a dietary intervention, but then people work with health specialists surrounding weight and physical activity, and they really intervene on multiple levels and try to equip you with the tools that are most helpful for them. So that's what's meant by intensive, it is intensive. So the ultimate goal is to help people achieve weight loss so as to reduce the likelihood of development to worsening or development of diabetes type 2. We've got a lot of participants with [inaudible] side, yeah. So over 5,000 participants in the intervention group versus the control, it's multi-site in many many years. People were already determined to have type 2 diabetes and were classified in the overweight range of BMI. The intervention had diabetes support and the intensive lifestyle intervention where the goal was to achieve 7 percent weight loss. That had been identified as an actual through variety of analyses to be determined to be a significant level of weight loss that actually can improve diabetes outcomes. So people went in for group and individual counseling weekly for six months and then tapering over time. So it would shift to every other week, then monthly, and then booster sessions for extended periods of time. The calorie goal was 1200 to 1800 calories. In some cases, people also received meal replacement products to help achieve that, meaning they would have like bars or shakes or something that had been determined to be highly nutritive. They were also prescribed at least a 175 minutes of moderate physical activity. What was found was that compared to the control group, very drastic effects for weight. So you can see the blue lines show weight over the course of time. Also, know that this is 10 years going out now. So in that first year when people were having the weekly meetings and were prescribed 12 to 1,800 calories per day, we see a predictable reduction in weight. This was maintained over time because people were also equipped with the skills and had the booster sessions to continue with the behavioral modification. So we see this across the board with respect to measures of physical fitness as well as the lipids and other kinds of glucose indices. We also saw, say we also saw. This is back when I was in graduate school and I was like a clinician and I am not an author on any of these papers, but what we see as audience members are also improvements in other psychosocial variables. So we were seeing real improvements with respect to depressive symptomatology and what people kind of, there is more of a trickle effect so people experienced improvements in their weight outcomes and in their physical fitness, but there's also trickles to other types of domains speaking to the importance of health behaviors more globally that we're not just talking about them in isolation. This is a stress score as well. So another similar motive improvement. So what we can conclude from the look ahead trials, and specifically this intensive multi-level multiple tools intervention was very effective in helping people modify their lifestyle, dietary as well as physical activity behaviors. Their diet score improved, their diet improved, and their actual physical outcomes improved, and mortality also improved. We can see now this is a now even longer trial, one of the obviously largest and most powerful interventions of its type. We also saw improvements with respect to mood. Well, we get mood well being in quality of life. I want people to especially think about these when trying to formulate not only clinical interventions and what we can learn from those, but also think again more broadly about how the lessons we've learned from these intervention trials can be broadened to more of a public health approach.
