A study finds that a partner's participation in a lifestyle change program can be a key to success, especially for weight loss.
Losing weight is hard. Losing weight by yourself is harder.
Conversely, working with a partner to lose weight increases the likelihood of success, according to research presented this weekend during the European Society of Cardiology 2020 Congress.
“Lifestyle improvement after a heart attack is a crucial part of preventing repeat events,” said study author Lotte Verweij, MS, a registered nurse from Amsterdam University of Applied Sciences, the Netherlands, in a statement. Verweij’s institution is located in the city that had been scheduled to host the ESC meeting, until the coronavirus disease 2019 (COVID-19) pandemic forced a virtual format.
The Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 (RESPONSE-2) trial, which presented its first results in 2017, showed that when people who survive heart attacks are referred to intensive, long-duration lifestyle modification programs, they have greater success in increasing their level of physical activity, quitting smoking, or embracing healthy eating habits than those who are simply referred to their physician for follow-up care.
The new results, presented in an electronic poster session at ESC, hone in on a key factor to success: the greatest improvements were seen in patients who took part in lifestyle programs and lived with a partner. “Our study shows that when spouses join the effort to change habits, patients have a better chance of becoming healthier—particularly when it comes to losing weight,” said Verweij, who is a PhD candidate.
For this follow-up study, researchers investigated the link between having a partner on the improvement of at least 1 lifestyle factor without deterioration in another factor over a 12 month period. As a secondary measure, researchers looked at how the level of partnership participation influenced the success of the individuals studied. Partner participation was defined as participating, non-participating, or no partner.
The lifestyle interventions and measurement tools were: (1) weekly sessions with a Weight Watchers coach for 12 months, (2) use of an accelerometer to measure activity, along with access to an online coach for individual feedback for 12 months, and (3) for smoking cessation, motivational interviewing over the telephone for 3 months, along with prescriptions for nicotine replacement or varenicline therapy if appropriate.
Usual care involved visits to a cardiologist and cardiac rehabilitation, as well as 4 visits to nurse-managed programs for healthy living.
Results. This new evaluation looked at 824 individuals, including 411 in the intervention group, and 413 controls (referred to usual care). The share of households with a partner present was relatively high for both groups: 74% for the intervention group, 69% for the control group.
“Patients with partners who joined the weight loss program lost more weight compared to patients with a partner who did not join the program,” Verweij said.
The importance of getting buy-in from significant others and family members has been acknowledged in successful long-duration lifestyle modification programs in the United States. A component of the National Diabetes Prevention Program, which has a core component of 16 weeks and follow-up through the balance of a 12-month period, involves teaching participants to engage family members in supporting their efforts to adopt healthy eating habits, especially if that means the person must say “no” to traditional meals or foods that are culturally important, or modify their preparation.
A Marion County, North Carolina program designed for residents with type 2 diabetes (T2D), organizers saw a 56% drop in medications needed, in part by encouraging participants to bring spouse or best friend to the yearlong sessions. A “family-focused” intervention developed at North Carolina Central University, focused on serving Black families, required the enrollee to bring the person in the household in charge of preparing the food to education sessions.
Verweij explained the practical matters involved. “Couples often have comparable lifestyles, and changing habits is difficult when only one person is making the effort. Practical issues come into play, such as grocery shopping, but also psychological challenges, where a supportive partner may help maintain motivation.”
The study found less improvement in smoking cessation and exercise. “These lifestyle issues might be more subject to individual motivation and persistence, but this hypothesis needs more investigation,” Verweij said.
Verweij L, Jorstad HT, Minneboo M, et al. The influence of partners on lifestyle-related risk factors in patients after an acute coronary syndrome. Results from the RESPONSE-2 randomized controlled trial. Presented at the European Society of Cardiology 2020 Congress, August 28, 2020.