Small weight gains during obesity treatment: normative or cause for concern?

Associations between self-monitoring and weight change in behavioral weight loss interventions

OBJECTIVE

The current study is a secondary analysis of the Live SMART trial, a randomized controlled trial comparing a behavioral weight loss (BWL) condition delivered via smartphone (SMART) to a group-based BWL condition (GROUP) and a control condition (CONTROL). Given the established importance of self-monitoring for weight loss, the aims were to evaluate bidirectional associations between adherence to self-monitoring and weight change and to examine the moderating effect of treatment condition on these associations.

METHOD

Adults with overweight/obesity (n = 276; 83% women; 92.8% White; Mage = 55.1 years; Mbody mass index = 35.2 kg/m2) were instructed to self-monitor dietary intake, daily weight, and physical activity minutes via paper diaries in GROUP and CONTROL and via a smartphone application in SMART. All participants were weighed monthly at the research center. Adherence to self-monitoring was assessed via examination of self-monitoring records.

RESULTS

Generalized linear mixed models revealed that adherence to self-monitoring of dietary intake, self-weighing, and physical activity for each month was associated with weight change throughout that month, such that increased frequency of self-monitoring led to greater weight loss (ps < .001). For the GROUP condition only, poorer weight losses in 1 month were prospectively associated with poor adherence to self-monitoring the following month (ps ≤ .01).

CONCLUSIONS

Results provide evidence of a bidirectional association between self-monitoring and weight change. Better self-monitoring was consistently associated with better weight loss across intervention and tracking modalities. Poorer weight loss was prospectively associated with poorer self-monitoring in group treatment, suggesting that social influences could drive adherence in this form of treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Variability in Weight Change Early in Behavioral Weight Loss Treatment: Theoretical and Clinical Implications

OBJECTIVE

Response early in weight loss treatment predicts long-term weight change. Weight variability, independent of absolute early weight change, may also relate to long-term outcomes. This study examined whether weight variability early in treatment predicted later weight loss and maintenance.

METHODS

Participants were 183 completers of a yearlong behavioral weight loss program (mean age = 51, 81% female, 69% white, mean BMI = 35  kg/m2 ). Weight variability was calculated using weights from the first 6 and 12 weekly treatment sessions. Multiple linear regressions examined whether weight variability predicted subsequent weight change 6, 12, and 24 months later.

RESULTS

Weight variability over 6- and 12-week periods predicted less subsequent weight loss at 12 months (6-week: β = 0.18, P = 0.02; 12-week: β = 0.33, P < 0.01) and 24 months (6-week: β = 0.17, P = 0.03; 12-week: β = 0.15, P = 0.05). Relationships held when adjusting for covariates. Weight variability was more strongly associated with 6-month weight change in men than women (β = 0.27, P = 0.01).

CONCLUSIONS

Elevated weight variability early in a weight loss program predicted poor long-term outcomes, possibly reflecting inconsistent weight control behaviors. Tracking weight variability could prove useful for improving treatment outcomes.

Small weight gains during obesity treatment: normative or cause for concern?

Objectives

The objectives of the study are to characterize the frequency and size of small weight gains during behavioural weight loss treatment and to evaluate the relationship between small weight gains and weight loss outcomes.

Methods

Participants (n = 281) in a year‐long behavioural weight loss programme were weighed at treatment sessions, and between‐session weight gains were classified into several categories based on size. The occurrence of different gain magnitudes and their relation to weight loss were examined during both the active weight loss (months 1–6) and weight loss maintenance (months 7–12) phases of treatment.

Results

Weight gains were common during both phases of treatment, with smaller gains occurring more frequently than larger gains. Greater frequency of all gain magnitudes was associated with lesser weight loss during both phases. Additionally, participants who had just one or two weight gains of the smallest size examined (1.0–1.9 lb) lost less weight than those who had no gains.

Conclusions

Small gains appear to reflect true weight gain due to poor adherence to behavioural recommendations and are associated with worse weight loss outcomes, even when limited in number. Future research should examine how best to prevent small weight gains from occurring and how clinicians and participants should respond when a weight gain does occur to promote weight control success.