Taking Action to Thrive - A Healthy Lifestyle Intervention Pilot Study
Condition: Overweight, Obesity and Other Hyperalimentation
MeSH terms: Overweight; Hyperphagia
Study type: Interventional

Summary: 
      There have been some preliminary studies, primarily in animals, that suggest that exposure to
      some of the chemicals in our everyday environment, such as the chemicals found in plastics,
      may cause weight gain. It is not clear whether this also happens in humans, or whether
      decreasing exposure to these chemicals can improve success with weight loss when people adopt
      healthy lifestyle changes.

      The THRIVE Study is a 4-week group healthy lifestyle education program that is designed to
      determine whether:

        -  changes in dietary habits and the types of personal care products used can decrease a
           person's exposure to chemicals in our environment that have been suggested to cause
           weight gain

        -  whether any measurable changes in body composition (fat tissue vs. lean tissue) can be
           seen as a result of participating in the healthy lifestyle program.
    

Detailed description: 
      Emerging evidence from in vitro and animal models suggests that exposure to endocrine
      disrupting chemicals (EDC), or industrial chemicals that alter hormonal action, may
      contribute to the development of obesity. Phthalates, a class of industrial chemicals
      commonly found in personal care products and food packaging, warrant study since they are
      widely detected in the general US population, including reproductive aged-women, and
      exposures during adulthood are associated with an increased risk of obesity. However, the
      majority of the evidence supporting this hypothesis to date has come from cross-sectional
      rather than prospective, longitudinal data. Thus, a causal relationship between EDC exposure
      and the development of obesity has not been conclusively established.

      Currently, 60.3% (95% CI: 54.2-66.0) of younger adult Americans (aged 20 - 39) are thought to
      be overweight or obese (BMI ≥25), which increases the risk of chronic diseases such as
      diabetes, cardiovascular disease and cancer. While excess calorie consumption and lack of
      physical activity are primary contributors to overweight and obesity, factors other than diet
      and physical activity may also contribute to alterations in energy balance over time. The
      general public is becoming increasingly concerned about the potential health risks associated
      with EDC exposures, including effects on body composition.

      The THRIVE Study is designed to evaluate the effect of many different EDCs on body
      composition changes. The study will focus initially on exposures to the phthalate class of
      EDCs, but data will be collected in a way that will allow investigators to evaluate the
      effect of many different EDCs on body composition changes.

      Phthalates are a class of high-production-volume industrial chemicals that are ubiquitously
      used in commerce. Most phthalates, such as DEHP, are used as plasticizers to impart
      flexibility in polyvinyl chloride (PVC) materials such as food packaging, flooring, and
      medical devices. In recent years, other phthalates, including diisononyl phthalate (DiNP),
      have been replacing DEHP in these applications due, in part, to legislation limiting the use
      of DEHP in certain applications such as children's toys. Phthalates can leach, migrate, or
      off-gas from products over time and enter the human body through the air we breathe, the food
      we eat, and the personal care products that we use on our bodies. Consequently, human
      exposure to phthalates is widespread.

      Phthalates enter foods through contact with plastics (e.g. tubing, conveyor belts or plastic
      gloves made with PVC plastics) or recycled paper/cardboard food containers. Phthalates are
      more likely to leach into liquids and non-polar solvents such as fats and oils, and thus are
      most commonly found in foods high in animal fats such as dairy products and meat.
      Low-molecular weight phthalates, such as DEP, di-n-butyl phthalate (DnBP) and DiBP, are
      commonly found in fragranced personal care products such as perfumes, deodorants, soaps,
      shampoos, and other hair products (e.g. hair sprays, gels, mousses). They can also be found
      in time release medications and supplements. Intervention studies suggest that addressing
      sources of exposure can lower human exposure to phthalates. In a study of 20 individuals, a
      3-day dietary intervention of "fresh foods" (no canned food or foods wrapped in plastic)
      resulted in an average reduction in DEHP metabolites of 53-56%. Similarly, a study of 100
      Latina girls found that a 3-day intervention with phthalate free personal care products
      resulted in a 27.4% reduction in DEP metabolite (mono-ethyl phthalate) levels.

      If phthalate exposures are ultimately found to be associated with body composition changes in
      young adults, it could be possible to decrease the risk of these body composition changes by
      modifying food selection, preparation and storage techniques, and changing use of personal
      care products in addition to traditional diet and physical activity interventions. This, in
      turn, could have significant impacts on obesity and chronic disease risk in the US.

      While a few studies have indicated that dietary modification and changes in personal care
      products use can individually lower urinary phthalate levels, this study will be the first to
      combine both a dietary and personal care product intervention. In a study of 20 individuals,
      a 3-day dietary intervention of "fresh foods" (no canned food or foods wrapped in plastic)
      resulted in an average reduction in DEHP metabolites of 53-56%. Similarly, a study of 100
      Latina girls found that a 3-day intervention with phthalate free personal care products
      resulted in a 27.4% reduction in DEP metabolite (mono-ethyl phthalate) levels. The hypothesis
      of this study is that an intervention that addresses both dietary and personal care product
      phthalate exposures can result in an even greater decrease in urinary phthalate metabolites.
    

Intervention name(s): endocrine disruptor chemical reduction intervention
Intervention type(s): Behavioral
Intervention description(s): Participants will take part in a 4-week intervention consisting of a modified (shortened) version of the Diabetes Prevention Program diet and physical activity group education program, with instructions to reduce endocrine disruptor chemical exposure through changes in food handling and personal care products.
Intervention MeSH terms: Endocrine Disruptors
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment