Adherence to behavioral recommendations for weight loss and associated psychosocial factors among African American adults

Environments and situations as correlates of eating and drinking among women living with obesity and urban poverty

Objective

One path to improving weight management may be to lessen the self‐control burden of physical activity and healthier food choices. Opportunities to lessen the self‐control burden might be uncovered by assessing the spatiotemporal experiences of individuals in daily context. This report aims to describe the time, place, and social context of eating and drinking and 6‐month weight change among 209 midlife women (n = 113 African–American) with obesity receiving safety‐net primary care.

Methods

Participants completed baseline and 6‐month weight measures, observations and interviews regarding obesogenic cues in the home environment, and up to 12 ecological momentary assessments (EMA) per day for 30 days inquiring about location, social context, and eating and drinking.

Results

Home was the most common location (62%) at times of EMA notifications. Participants reported “yes” to eating or drinking at the time of nearly one in three (31.1% ± 13.2%) EMA notifications. Regarding social situations, being alone was significantly associated with less frequent eating and drinking (OR = 0.75) unless at work in which case being alone was significantly associated with a greater frequency of eating or drinking (OR = 1.43). At work, eating was most common late at night, whereas at home eating was most frequent in the afternoon and evening hours. However, eating and drinking frequency was not associated with 6‐month weight change.

Conclusions

Home and work locations, time of day, and whether alone may be important dimensions to consider in the pursuit of more effective weight loss interventions. Opportunities to personalize weight management interventions, whether digital or human, and lessen in‐the‐moment self‐control burden might lie in identifying times and locations most associated with caloric consumption.

Clinical trial registration: NCT03083964 in clinicaltrials.gov

Impact of income and perceived stress on engagement and weight loss outcomes in an online behavioral weight loss program

Lower income is associated with greater stress, and stress has been shown to undermine treatment engagement and weight loss outcomes in face-to-face interventions. The present study examined whether lower income predicts treatment engagement and weight loss outcomes during an online behavioral weight loss (BWL) intervention. A total of N = 260 participants (79.2% female; 50.7 ± 11.9 years of age; 60.3% non-Hispanic White) were enrolled into an online BWL program and had their income, stress, program engagement, and weight measured. Results showed that stress fully mediated the effect of income on engagement in the online program. Further, lower income predicted poorer weight loss outcomes, and this effect was partially mediated by perceived stress. This is the first study to demonstrate that lower income is associated with poorer engagement and weight loss outcomes in an online weight loss program, underscoring the need for systems-level stress reduction programs and individual level stress management tools, particularly for individuals with lower income.