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Behavior, Psychology and Sociology

Halo effect of a Mediterranean-lifestyle weight-loss intervention on untreated family members’ weight and physical activity: a prospective study



Obesity is subject to strong family clustering. The relatives of participants in weight-loss interventions may also modify their lifestyle and lose weight. The aim of this study was to examine the presence and magnitude of a halo effect in untreated family members of participants enrolled in a randomized, multi-component, lifestyle intervention.


A total of 148 untreated adult family members of participants in an intensive weight-loss lifestyle intervention (the PREDIMED-Plus study) were included. Changes at 1 and 2 years in body weight, physical activity, and adherence to a traditional Mediterranean diet (MedDiet) were measured. Generalized linear mixed models were used to assess whether the change differed between family members of the intervention group compared to the control.


Untreated family members from the intervention group displayed a greater weight loss than those from the control after 1 and 2 years: adjusted 2-year weight change difference between groups was −3.98 (SE 1.10) kg (p < 0.001). There was a halo effect with regard to adherence to the MedDiet at one year which was sustained at two years: 2-year adjusted difference in MedDiet score change +3.25 (SE 0.46) (p < 0.001). In contrast, no halo effect was observed with regard to physical activity, as the untreated family members did not substantially modify their physical activity levels in either group, and the adjusted difference at two years between the 2 groups was −272 (SE 624) METs.min/week (p = 0.665).


In the first prospective study to assess the influence on untreated family members of a diet and physical activity weight-loss intervention, we found evidence of a halo effect in relatives on weight loss and improvement in adherence to a MedDiet, but not on physical activity. The expansion of MedDiet changes from individuals involved in a weight-loss intervention to their family members can be a facilitator for obesity prevention.

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Fig. 1: Flow chart of the halo study.
Fig. 2: Halo effect results in weight, physical activity and MedDiet adherence.
Fig. 3: Halo effect correlation.


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OC was funded with JR17/00022. This work was supported by the Strategic Plan of Research and Innovation in Health (PERIS) 2016-2020, Department of the Generalitat de Catalunya, and Instituto de Salud Carlos III (ISCIII). CL is supported by the Beatriu de Pinós postdoctoral program of the Government of Catalonia’s Secretariat for Universities and Research of the Ministry of Economy and Knowledge [2017-BP-00021].

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SUPPLEMENTAL TABLE 1: Halo effect on weight loss by tertiles of weight change of the PREDIMEDplus participants from the intervention group 1 year from baseline.


SUPPLEMENTAL TABLE 2: Halo effect on weight loss by tertiles of weight change of the PREDIMEDplus participants from the intervention group 2 years from baseline.

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Zomeño, M.D., Lassale, C., Perez-Vega, A. et al. Halo effect of a Mediterranean-lifestyle weight-loss intervention on untreated family members’ weight and physical activity: a prospective study. Int J Obes 45, 1240–1248 (2021).

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