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Spreckley M, de Lange J, Seidell J, Halberstadt J. Primary care-led weight-management intervention: qualitative insights into patient experiences at one-year follow up. Int J Qual Stud Health Well-being 2023; 18:2256669. [PMID: 37703440 PMCID: PMC10501160 DOI: 10.1080/17482631.2023.2256669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION The global prevalence of overweight and obesity is continuously increasing. Long-term weight loss results remain disappointing. This study aims to identify factors and strategies for successful long-term weight loss in a primary care-led weight-loss intervention from the perspective of participants. MATERIALS AND METHODS This qualitative interview study is the first follow-up study in a 2-year study series of participants with overweight or obesity. Methods utilized are semi-structured interviews (n = 20) with quantitative self-description. The data were transcribed from audio-taped interviews and analysed thematically. RESULTS This study found that clear, continuously evolving self-monitoring strategies facilitated by strong routines and a long-term focus enhanced successful outcomes. Challenges faced included stress, disappointment and loss of routine along with external criticism and discouragement. Benefits experienced due to weight loss included improved health, self-esteem, communal support and encouragement, which continued to fuel motivation. Receiving continuous support and encouragement from healthcare practitioners was instrumental for long-term success. CONCLUSION This study highlighted the complex, multifaceted experiences patients encounter in the pursuit of trying to achieve long-term weight loss. Personalized treatment protocols taking into account the diverse requirements and circumstances of individuals have the potential to improve treatment outcomes. Continuous, professional support may enhance long-term outcomes.
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Affiliation(s)
- Marie Spreckley
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Judith de Lange
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jaap Seidell
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jutka Halberstadt
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Phelan S, Cardel MI, Lee AM, Alarcon N, Foster GD. Behavioral, psychological, and environmental predictors of weight regain in a group of successful weight losers in a widely available weight-management program. Obesity (Silver Spring) 2023; 31:2709-2719. [PMID: 37840409 DOI: 10.1002/oby.23903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The aim of this study was to identify predictors of weight regain and continued weight maintenance among individuals already successful at long-term weight loss in a widely available weight-management program. METHODS Participants were 2843 weight-loss maintainers in WeightWatchers who had maintained weight loss ≥9.1 kg for ≥1 year (average 25.5 kg for 3.5 years; BMI = 26.7 kg/m2 ). Validated behavioral, psychosocial, and home environmental questionnaires were administered at study entry and 1 year later. Discriminant analysis identified variables that discriminated gainers (≥2.3-kg gain) from maintainers (±2.3-kg change). RESULTS Over the 1 year of follow-up, 43% were gainers (mean [SD], 7.2 [5.4] kg), and 57% were maintainers (0.4 [1.2] kg). Compared with maintainers, gainers were younger and had higher initial weight, more recent weight losses, and larger initial weight losses. Standardized canonical coefficients indicated that the 1-year changes that most discriminated gainers from maintainers were greater decreases in the ability to accept uncomfortable food cravings, urges, and desires to overeat (0.232); self-monitoring (0.166); body image (0.363); and body satisfaction (0.194) and greater increases in disinhibition (0.309) and bodily pain (0.147). The canonical correlation was 0.505 (p < 0.001). CONCLUSIONS Future interventions to prevent regain should consider targeting overeating in response to internal and external food cues and declines in self-monitoring and body image.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Michelle I Cardel
- WW International, Inc., New York, New York, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Noemi Alarcon
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Gary D Foster
- WW International, Inc., New York, New York, USA
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Yıldız E, Karagözoğlu Ş. The Effects of a Web-Based Interactive Nurse Support Program Based on the Health Promotion Model on Healthy Living Behaviors and Self-Efficacy in Patients Who Regained Weight after Bariatric Surgery: A Randomized Controlled Trial. Obes Surg 2023; 33:3212-3222. [PMID: 37620740 DOI: 10.1007/s11695-023-06795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This study was conducted in order to determine the effects of web-based interactive nursing support program prepared in line with Health Promotion Model (HPM) on healthy lifestyle behaviors and self-efficacy of patients who regained weight following metabolic and bariatric surgery. MATERIALS AND METHODS A total of 62 patients with a history of weight regain at least two years after metabolic and bariatric surgery were divided into intervention (n = 31) and control (n = 31) groups by stratified randomization. The intervention group was given a web-based interactive nurse support program based on HPM for 10 weeks and followed up by telephone 12 times (every two weeks) in 6 months. No attempt was made to the control group during the study. The data were collected a total of 3 times before the training, in the 12th week and in the 6th month. RESULTS In the last test after the web-based interactive nurse support program and telephone follow-up, the difference was found to be statistically significant in terms of BMI, healthy lifestyle behaviors, eating behaviors, and general self-efficacy mean scores of the patients in the intervention group (p < 0.05). In addition, after the study, it was determined that the physical activity, nutrition, spiritual development, emotional eating and the Dutch Eating Behavior scales total score averages and Self-Efficacy Scale total score averages of the intervention group changed positively compared to the control group, and this change was statistically significant (p < 0.05). There was no difference between the groups in the mean scores of health responsibility, interpersonal relationships, stress, restrictive eating, external eating and Healthy Lifestyle Behaviors-II Scale (p > 0.05). CONCLUSION It can be stated that the web-based interactive nurse support program based on HPM is applicable in patients who regain weight after metabolic and bariatric surgery, and it contributes positively to the healthy lifestyle behaviors, BMI, eating behaviors, and general self-efficacy of these patients. In order to ensure the continuity of post-operative patient follow-up, it is recommended to increase the importance of telephone counseling and to establish follow-up program based on the HPM.
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Affiliation(s)
- Ezgi Yıldız
- Susehri School of Health Nursing Department, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Şerife Karagözoğlu
- Faculty of Health Sciences Fundamentals of Nursing Department, Sivas Cumhuriyet University, Sivas, Turkey
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Attitudes to Three Weight Maintenance Strategies: A Qualitative Study. Nutrients 2022; 14:nu14214441. [PMID: 36364704 PMCID: PMC9655049 DOI: 10.3390/nu14214441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Weight loss maintenance can be difficult and ultimately unsuccessful, due to psychological, behavioural, social, and physiological influences. The present study investigated three strategies with the potential to improve weight maintenance success: daily weighing, missing an occasional meal, habitually changing high energy foods. The principal aim was to gain an understanding of attitudes to these strategies in participants who had recent experience of weight loss attempts, with or without maintenance. This was a qualitative study involving semi-structured interviews, with 20 participants aged 18–67 (twelve females), analysed using thematic analysis. Most participants disliked daily weighing and missing an occasional meal for long-term maintenance and were concerned about potential negative effects on mental health. All participants had experience of habitual changes to high energy foods and regarded this strategy as obvious and straightforward. Replacement of high energy foods was favoured over elimination. Participants preferred strategies that felt flexible, “normal” and intuitive and disliked those that were thought to have a negative impact on mental health. Further investigation is needed on whether concerns regarding mental health are well founded and, if not, how the strategies can be made more acceptable and useful.
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Spreckley M, de Lange J, Seidell JC, Halberstadt J. Patient insights into the experience of trying to achieve weight-loss and future expectations upon commencement of a primary care-led weight management intervention: A qualitative, baseline exploration. PLoS One 2022; 17:e0270426. [PMID: 35767563 PMCID: PMC9242434 DOI: 10.1371/journal.pone.0270426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The long-term effects of interventions aiming to achieve substantial, sustainable weight loss maintenance have been disappointing. Most people regain their lost weight over time but some seem to be able to maintain their weight loss. We are following the experiences of patients over time prospectively. This study forms the baseline to provide insights into patient experiences prior to entering a primary care-led weight management intervention and their expectations going forward. Materials and methods We recruited 21 adult male and female patients of varying ethnicity with a BMI between 27.7kg/m2 and 48.4kg/m2 from a cohort of patients entering a primary care-led weight management intervention. Patients were offered video and audio interview options during the COVID-19 lockdown. In total, twenty chose the audio option, while one chose the video option. The interview format was semi-structured with room for individual exploration. Discussion We found that participants experienced feeling unable to control their weight and encountered a multitude of internal and external barriers to weight management. Some had supportive environments, while others experienced discouraging external influences. Though personal characteristics varied, motivations, goals and expected benefits were similar across this cohort. Most participants had previously experienced transient successful weight-loss attempts with varying approaches. COVID-19 was experienced as an opportunity or barrier for change. Conclusion This study illustrates the importance of gaining comprehensive insights into the diverse experiences patients encounter when trying to achieve weight loss. Personalized support taking into account individual experiences and circumstances may enhance long-term treatment outcomes. Future research into the complexities of weight management based on individual accounts can aid in the creation of improved treatment protocols.
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Affiliation(s)
- Marie Spreckley
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- * E-mail:
| | - Judith de Lange
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jacob C. Seidell
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jutka Halberstadt
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Ames GE, Koball AM, Clark MM. Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery. Front Endocrinol (Lausanne) 2022; 13:934680. [PMID: 35923629 PMCID: PMC9339601 DOI: 10.3389/fendo.2022.934680] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Weight regain after bariatric surgery is associated with problematic eating behaviors that have either recurred after a period of improvement or are new-onset behaviors. Problematic eating behaviors after bariatric surgery have been conceptualized in different ways in the literature, such as having a food addiction and experiencing a loss of control of eating. The intersection of these constructs appears to be driven overeating defined as patients' experiences of reduced control of their eating which results in overeating behavior. The purpose of this review is to define patient experiences of driven overeating through the behavioral expression of emotion-based eating, reward-based eating, and executive functioning deficits-namely impulsivity-which is associated with weight regain after having bariatric surgery. Delineating concepts in this way and determining treatment strategies accordingly may reduce distress related to the inevitable return of increased hunger, cravings, portion sizes, and tolerance for highly palatable foods after surgery. Along with standard behavioral weight maintenance strategies, topics including acceptance, motivation, emotion-based eating, reward-based/impulsive eating, physical activity, and self-compassion are discussed. These concepts have been adapted for patients experiencing weight regain after having bariatric surgery and may be particularly helpful in attenuating driven overeating and weight regain.
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Affiliation(s)
- Gretchen E. Ames
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States
- *Correspondence: Gretchen E. Ames,
| | - Afton M. Koball
- Department of Behavioral Health, Gundersen Health System, La Crosse, WI, United States
| | - Matthew M. Clark
- Department of Psychiatry and Psychology and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, United States
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Goldstein SP, Zhang F, Klasnja P, Hoover A, Wing RR, Thomas JG. Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial. JMIR Res Protoc 2021; 10:e33568. [PMID: 34874892 PMCID: PMC8691411 DOI: 10.2196/33568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Behavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT. OBJECTIVE The aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions. METHODS Adults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment. RESULTS The recruitment for the microrandomized trial began on April 19, 2021, and is ongoing. CONCLUSIONS This study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss). TRIAL REGISTRATION ClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33568.
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Affiliation(s)
- Stephanie P Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Fengqing Zhang
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Adam Hoover
- Holcombe Department of Electrical and Computer Engineering, Clemson University, Clemson, SC, United States
| | - Rena R Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - John Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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Spreckley M, Seidell J, Halberstadt J. Perspectives into the experience of successful, substantial long-term weight-loss maintenance: a systematic review. Int J Qual Stud Health Well-being 2021; 16:1862481. [PMID: 33455563 PMCID: PMC7833027 DOI: 10.1080/17482631.2020.1862481] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose: In light of the increasing prevalence of overweight and obesity, understanding the experiences, strategies and challenges encountered when trying to achieve substantial, sustainable weight loss is an important area to investigate. We systematically evaluated qualitative studies focusing on the accounts of individuals who have achieved sustained weight loss to create a comprehensive picture of the experience of sustainable weight loss. Methods: Included studies were peer-reviewed studies that qualitatively assessed the views and experiences of adults who previously had or currently have overweight or obesity who successfully lost weight and who subsequently maintained or regained weight. The evidence was systematically synthesized, which enabled the formulation of clear themes and recommendations. Results: The 15 chosen studies included the accounts of 294 individuals. We found that continuous monitoring and goal setting, driven by sustained motivation and encouraging experiences, while resisting ever present challenges and enduring discouraging experience encapsulates the experience of sustained, substantial weight loss. Conclusions: This review aims to provide a comprehensive understanding of the experiences, strategies and challenges encountered when trying to achieve substantial, sustained weight loss. Additional research taking into account findings from this review and others of its kind will enhance the formulation of treatment protocols.
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Affiliation(s)
- Marie Spreckley
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam , Amsterdam, Netherlands
| | - Jaap Seidell
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam , Amsterdam, Netherlands
| | - Jutka Halberstadt
- Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam , Amsterdam, Netherlands
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Lillis J, Dunsiger S, Thomas JG, Ross KM, Wing RR. Novel behavioral interventions to improve long-term weight loss: A randomized trial of acceptance and commitment therapy or self-regulation for weight loss maintenance. J Behav Med 2021; 44:527-540. [PMID: 33772702 DOI: 10.1007/s10865-021-00215-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Maintenance of weight loss is hard to achieve, and novel interventions are needed to improve long-term outcomes. In this pilot randomized controlled trial, N = 188 participants received an online, 12-week weight loss intervention and N = 102 who lost ≥ 5% were then randomly assigned to a 1-day, 5-h workshop based on Acceptance and Commitment Therapy (ACT), Self-Regulation (SR), or no workshop (Control) with 3 months of limited email follow-up. Assessments were conducted at baseline, 3, 6, 12, 18, and 24 months. The primary outcome was percent weight change; secondary outcomes were weight-related experiential avoidance and health values-consistent behavior. ACT had greater overall weight loss (-7.18%, SE = 1.33) when compared to Control (-1.15%, SE = 1.50; p = .03). Post hoc analyses showed that ACT had significantly greater weight losses than Control (6.11%, β = -2.03, p = .048) among those with lower initial weight loss (5-7%), and significantly greater weight loss than SR (6.19%, β = -1.77, p = .05) among those with the highest initial weight losses (10% +). There is potential for continuing to develop ACT in a limited interventionist-contact format with modifications. This pilot study represents an innovative model for behavioral weight loss by reversing the typical treatment intensity model with the aim of providing interventionist support during a critical period after initial weight loss. REGISTRATION: Clinicaltrials.org #NCT02156752 https://www.clinicaltrials.gov/ct2/show/NCT02156752 .
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Affiliation(s)
- J Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 20903, USA.
| | - S Dunsiger
- Center for Health Promotion and Health Equity, School of Public Health, Brown University, Providence, RI, USA
| | - J G Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 20903, USA
| | - K M Ross
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - R R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 20903, USA
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Lillis J, Schumacher L, Thomas JG, Levin ME, Dunsiger S, Unick JL, Evans E, Hayes JF, Wing RR. Study protocol for a randomized controlled trial comparing two low-intensity weight loss maintenance interventions based on acceptance and commitment therapy or self-regulation. Contemp Clin Trials 2021; 103:106327. [PMID: 33631360 DOI: 10.1016/j.cct.2021.106327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Weight regain is common following behavioral obesity treatment and attenuates many of the benefits of initial weight loss. This paper describes a randomized controlled trial that will evaluate the efficacy of two low-contact weight loss maintenance interventions based on Acceptance and Commitment Therapy (ACT) and self-regulation (SR). Potential mechanisms of action and moderators of treatment effects will also be evaluated. METHODS Adults (anticipated N = 480) with overweight or obesity will complete an initial 3-month online weight loss program (Phase 1). Participants who achieve ≥4 kg weight loss (anticipated N = 288) will then be randomized to an ACT or SR weight loss maintenance intervention. Both interventions will entail four 2.5 h, face-to-face, group-based workshop sessions and 6 months of email contact. Assessments will be conducted at phase 1 baseline, phase 1 completion/pre-randomization, and 6, 12, 18, 24, and 30 months post-randomization. The primary outcome will be weight change for the period from randomization to 30 months. Potential process measures including ACT-based constructs (e.g., psychological acceptance, values-consistent behavior), self-weighing frequency, and motivation will be also be assessed, as will potential moderators (e.g., initial weight loss). CONCLUSIONS This study will compare the efficacy of two intervention approaches (ACT and SR) delivered in a scalable workshop format for long-term weight loss maintenance. Future research could examine efficacy and cost-effectiveness of these approaches in real world settings.
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Affiliation(s)
- Jason Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA.
| | - Leah Schumacher
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, RI, USA
| | - Jessica L Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Erin Evans
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Jacqueline F Hayes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
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Plummer A, Walker I. Can self-regulation explain why not everyone is overweight or obese? AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1883999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ann Plummer
- Discipline of Psychology, University of Canberra, Canberra, Australia
| | - Iain Walker
- Discipline of Psychology, University of Canberra, Canberra, Australia
- Research School of Psychology, Australian National University, Australia
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Thøgersen-Ntoumani C, Dodos LA, Stenling A, Ntoumanis N. Does self-compassion help to deal with dietary lapses among overweight and obese adults who pursue weight-loss goals? Br J Health Psychol 2020; 26:767-788. [PMID: 33368932 PMCID: PMC8451927 DOI: 10.1111/bjhp.12499] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/14/2020] [Indexed: 12/11/2022]
Abstract
Objectives Self‐compassion can facilitate self‐improvement motivation. We examined the effects of self‐compassion in response to dietary lapses on outcomes relevant to weight‐loss strivings using a longitudinal design. The indirect effects of self‐compassion via guilt and shame were also explored. Design An Ecological Momentary Assessment methodology was employed with a sample of adults who were overweight or obese attempting to lose weight via dietary restriction (N = 56; Mage = 34.88; SD = 13.93; MBMI = 32.50; SD = 6.88) and who responded to brief surveys sent to their mobile phones twice daily for two weeks. Methods Dietary temptations and lapses were assessed at each diary entry, and self‐compassion in response to dietary lapses, intention to continue dieting, weight‐loss‐related self‐efficacy, negative reactions to the lapse, and self‐conscious emotions were surveyed on occasions when participants reported having experienced a dietary lapse. The participants were also weighed in a laboratory prior to the EMA phase and via self‐report straight after the EMA phase. Weight was measured again in the laboratory 12 weeks after the EMA period. Results Bayesian multilevel path analyses showed that self‐compassion did not predict weight loss. However, at the within‐person level, self‐compassion was positively related to intentions and self‐efficacy to continue dieting, and negatively related to negative affective reactions to the lapses. Guilt mediated the associations of self‐compassion with intention, self‐efficacy, and negative reactions. Conclusion Self‐compassion may be a powerful internal resource to cultivate when dieters experience inevitable setbacks during weight‐loss strivings which could facilitate weight‐loss perseverance.
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Affiliation(s)
- Cecilie Thøgersen-Ntoumani
- Physical Activity & Well-Being Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Louisa A Dodos
- Physical Activity & Well-Being Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Andreas Stenling
- Department of Psychology, Umeå University, Sweden.,Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Nikos Ntoumanis
- Physical Activity & Well-Being Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
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Asbjørnsen RA, Wentzel J, Smedsrød ML, Hjelmesæth J, Clark MM, Solberg Nes L, Van Gemert-Pijnen JEWC. Identifying Persuasive Design Principles and Behavior Change Techniques Supporting End User Values and Needs in eHealth Interventions for Long-Term Weight Loss Maintenance: Qualitative Study. J Med Internet Res 2020; 22:e22598. [PMID: 33252347 PMCID: PMC7735908 DOI: 10.2196/22598] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/23/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND An increasing number of eHealth interventions aim to support healthy behaviors that facilitate weight loss. However, there is limited evidence of the effectiveness of the interventions and little focus on weight loss maintenance. Knowledge about end user values and needs is essential to create meaningful and effective eHealth interventions, and to identify persuasive system design (PSD) principles and behavior change techniques (BCTs) that may contribute to the behavior change required for successful long-term weight loss maintenance. OBJECTIVE This study aimed to provide insight into the design of eHealth interventions supporting behavior change for long-term weight maintenance. The study sought to identify the values and needs of people with obesity aiming to maintain weight after weight loss, and to identify PSD principles, BCTs, and design requirements that potentially enable an eHealth intervention to meet end user values and needs. METHODS This study presents the concept of integrating PSD principles and BCTs into the design process of eHealth interventions to meet user values and needs. In this study, individual interviews and focus groups were conducted with people with obesity (n=23) and other key stakeholders (n=27) to explore end user values and needs related to weight loss maintenance. Design thinking methods were applied during the focus group sessions to identify design elements and to explore how eHealth solutions can support the needs to achieve sustainable weight loss maintenance. The PSD model and behavior change taxonomy by Michie were used to identify PSD principles and BCT clusters to meet end user values and needs. RESULTS A total of 8 key end user values were identified, reflecting user needs for weight loss maintenance support: self-management, personalized care, autonomy, feel supported, positive self-image, motivation, happiness, and health. Goals and planning, feedback and monitoring, repetition and substitution, shaping knowledge, social support, identity, and self-belief were some of the BCT clusters identified to address these concepts, together with PSD principles such as personalization, tailoring, self-monitoring, praise, and suggestions. CONCLUSIONS The process of translating end user values and needs into design elements or features of eHealth technologies is an important part of the design process. To our knowledge, this is the first study to explore how PSD principles and BCTs can be integrated when designing eHealth self-management interventions for long-term weight loss maintenance. End users and other key stakeholders highlighted important factors to be considered in the design of eHealth interventions supporting sustained behavior change. The PSD principles and BCTs identified provide insights and suggestions about design elements and features to include for supporting weight loss maintenance. The findings indicate that a combination of BCTs and PSD principles may be needed in evidence-based eHealth interventions to stimulate motivation and adherence to support healthy behaviors and sustained weight loss maintenance. TRIAL REGISTRATION ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988.
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Affiliation(s)
- Rikke Aune Asbjørnsen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Research and Innovation Department, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Jobke Wentzel
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Research Group IT Innovations in Health Care, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | | | - Jøran Hjelmesæth
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Matthew M Clark
- Department of Psychiatry & Psychology, Mayo Clinic, College of Medicine & Science, Rochester, MN, United States
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Department of Psychiatry & Psychology, Mayo Clinic, College of Medicine & Science, Rochester, MN, United States.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Julia E W C Van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,University Medical Center Groningen, Groningen, Netherlands.,University of Waterloo, Waterloo, ON, Canada
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14
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Lawlor ER, Hughes CA, Duschinsky R, Pountain GD, Hill AJ, Griffin SJ, Ahern AL. Cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" among weight-loss maintainers and regainers: A qualitative study. Clin Obes 2020; 10:e12395. [PMID: 32767708 PMCID: PMC7116423 DOI: 10.1111/cob.12395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 02/02/2023]
Abstract
While many behavioural weight management programmes are effective in the short-term, post-programme weight regain is common. Overcoming "lapses" and preventing "relapse" has been highlighted as important in weight-loss maintenance, but little is known on how this is achieved. This study aimed to compare the cognitive and behavioural strategies employed to overcome "lapses" and prevent "relapse" by people who had regained weight or maintained weight-loss after participating in a weight management programme. By investigating differences between groups, we intended to identify strategies associated with better weight-loss maintenance. Semi-structured interviews were conducted with 26 participants (58% female) recruited from the 5-year follow-up of the Weight Loss Referrals for Adults in Primary Care (WRAP) trial (evaluation of a commercial weight-loss programme). Participants who had lost ≥5% baseline weight during the active intervention were purposively sampled according to 5-year weight trajectories (n = 16 'Regainers', n = 10 'Maintainers'). Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Key differences in strategies were that Maintainers continued to pay attention to their dietary intake, anticipated and planned for potential lapses in high-risk situations, and managed impulses using distraction techniques. Regainers did not report making plans, used relaxed dietary monitoring, found distraction techniques to be ineffective and appeared to have difficulty navigating food within interpersonal relationships. This study is one of the longest qualitative follow-ups of a weight loss trial to date, offering unique insights into long-term maintenance. Future programmes should emphasize strategies focusing on self-monitoring, planning and managing interpersonal relationships to help participants successfully maintain weight-loss in the longer-term.
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Affiliation(s)
- Emma R Lawlor
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Carly A Hughes
- Fakenham Medical Practice, Norfolk, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Robbie Duschinsky
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, England
| | | | - Andrew J Hill
- Division of Psychological & Social Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, England
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
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15
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Exploring the role of goal setting in weight loss for adults recently diagnosed with pre-diabetes. BMC Nurs 2020; 19:67. [PMID: 32684841 PMCID: PMC7362527 DOI: 10.1186/s12912-020-00462-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 07/12/2020] [Indexed: 11/25/2022] Open
Abstract
Background The management of prediabetes in the community setting is a global priority. We evaluated the feasibility of a 6-month multilevel practice nurse-led prediabetes dietary intervention which involved goal setting. The aim of this paper is to explore the weight loss goals and strategies reported by participants to achieve their weight loss goals as recorded by practice nurses, and report on factors that influenced dietary behaviours. Methods This study used a convergent mixed-methods design. A six-month pragmatic non-randomised pilot study with a qualitative process evaluation was conducted in two neighbouring provincial cities in New Zealand. A structured dietary intervention delivered by practice nurses was implemented in four practices in 2014–2016. Content analysis of the text and descriptive statistics were used to analyse the data. Results One hundred and fifty seven people with prediabetes were enrolled (85 intervention, 72 control). The intervention group lost a mean 1.3 kg more than the control group (p < .0.001). The majority of the intervention group indicated either a high level of readiness (n = 42, 53%) or some readiness (n = 31, 39%) to make food changes. The majority of weight loss goals aligned with clinical guidelines (between 5 and 10% of body weight). While just over half (n = 47, 55%) demonstrated weight loss at the end of the six month period, the majority of participants did not achieve their predetermined weight loss goal (n = 78, 83%). Gender, ethnicity and budget were not related to weight loss at six months. Readiness to change and reported challenges to making dietary changes were related to weight loss at six months. Negative factors or set-backs included sporadic adherence to diet due to other health problems, change in context or environment and coping with ill health, most notably stress and low mood. Conclusions The data relating to weight loss and dietary goals provided insight into the challenges that people faced in making dietary changes for weight loss across a six month period. Simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the person, in a socially supportive environment, may increase the success of goal achievement. Trial registration ANZCTR ACTRN1261500080656. Registered 3 August 2015 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366560&isReview=true
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16
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Rehackova L, Araújo-Soares V, Steven S, Adamson AJ, Taylor R, Sniehotta FF. Behaviour change during dietary Type 2 diabetes remission: a longitudinal qualitative evaluation of an intervention using a very low energy diet. Diabet Med 2020; 37:953-962. [PMID: 31269276 DOI: 10.1111/dme.14066] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 01/21/2023]
Abstract
AIM To understand the process of behaviour change through the experiences of people with Type 2 diabetes engaged in an 8-month diabetes remission intervention including a 2-month weight loss phase with the use of a very low energy diet (VLED), and a 6-month, structured weight maintenance phase. METHODS Data were collected in three semi-structured interviews at baseline, week 8 (end of the weight loss phase), and month 8 (end of the weight maintenance phase). Longitudinal inductive thematic analysis was used to analyse participants' narratives and identify change over time. RESULTS Eleven of 18 participants completed all three interviews. The following themes of change were identified in their narratives: (1) 'Building behavioural autonomy' as a process of growing confidence to engage in health behaviours that are independent of those of other people; (2) 'Behavioural contagion' describing how one's new health behaviours tend to affect those of other people; (3) 'From rigid to flexible restraint', reflecting the changes in attitudes and behaviours required for a successful adaptation from weight loss to weight maintenance; and (4) 'Shift in identity', representing changes in the participants' perceptions of themselves. CONCLUSIONS This longitudinal qualitative study provided new insights into how behaviour change is experienced by people with Type 2 diabetes engaged on a weight management intervention using VLED, contributing to theoretical and practical understanding of weight management behaviours. The themes identify potential areas in which individuals can be supported in achieving dietary diabetes remission and long-term maintenance of weight loss.
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Affiliation(s)
- L Rehackova
- Department of Health Psychology, Newcastle University, Newcastle, UK
| | - V Araújo-Soares
- Department of Health Psychology, Newcastle University, Newcastle, UK
| | - S Steven
- Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - A J Adamson
- Department of Health Psychology, Newcastle University, Newcastle, UK
- Human Nutrition Research Centre, Institute of Health & Society, Newcastle University, Newcastle, UK
- Fuse, the UK Clinical Research Collaboration Centre for Translational Research in Public Health, Newcastle, UK
| | - R Taylor
- Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - F F Sniehotta
- Department of Health Psychology, Newcastle University, Newcastle, UK
- Fuse, the UK Clinical Research Collaboration Centre for Translational Research in Public Health, Newcastle, UK
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17
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Hernández-Reyes A, Cámara-Martos F, Vidal Á, Molina-Luque R, Moreno-Rojas R. Effects of Self-Weighing During Weight Loss Treatment: A 6-Month Randomized Controlled Trial. Front Psychol 2020; 11:397. [PMID: 32210897 PMCID: PMC7077514 DOI: 10.3389/fpsyg.2020.00397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/20/2020] [Indexed: 01/18/2023] Open
Abstract
Objective To examine the effectiveness of self-weighing for weight loss in men for 6 months. Methods In the present study, 54 men, mean age of 40.1 ± 11.1 years, with overweight or obesity, were recruited and randomly assigned into two groups: control group (CG), without weight self-monitoring and intervention group (IG), with weight self-monitoring. Both groups received the same nutritional and educational advice and the establishment of a weight target to reach in the weight loss program. Subjects of IG also had individualized motivating content to improve self-management for 24 weeks. Anthropometric indices were measured at baseline and weekly for 24 weeks. Results When the group assigned after randomization was introduced in the analysis, its influence was significant in weight loss (F1.52 = 19.465, ± 2 = 0.272, p < 0.001) and in the decrease in body fat percentage (F1.52 = 8,306, ± 2 = 0.132, p < 0.01). Conclusion Study results indicate that self-weighing can help patients to lose additional weight. Our findings have implications in the emerging area of the behavioral approach of patients undergoing weight-loss treatment, as well as clinical care processes. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT04032249.
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Affiliation(s)
| | | | - Ángela Vidal
- Department of Animal Medicine and Surgery, University of Córdoba, Córdoba, Spain
| | | | - Rafael Moreno-Rojas
- Department of Bromatology and Food Technology, University of Córdoba, Córdoba, Spain
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18
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Frie K, Hartmann-Boyce J, Jebb S, Oke J, Aveyard P. Patterns in Weight and Physical Activity Tracking Data Preceding a Stop in Weight Monitoring: Observational Analysis. J Med Internet Res 2020; 22:e15790. [PMID: 32181749 PMCID: PMC7109615 DOI: 10.2196/15790] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/13/2019] [Accepted: 12/31/2019] [Indexed: 01/16/2023] Open
Abstract
Background Self-regulation for weight loss requires regular self-monitoring of weight, but the frequency of weight tracking commonly declines over time. Objective This study aimed to investigate whether it is a decline in weight loss or a drop in motivation to lose weight (using physical activity tracking as a proxy) that may be prompting a stop in weight monitoring. Methods We analyzed weight and physical activity data from 1605 Withings Health Mate app users, who had set a weight loss goal and stopped tracking their weight for at least six weeks after a minimum of 16 weeks of continuous tracking. Mixed effects models compared weight change, average daily steps, and physical activity tracking frequency between a 4-week period of continuous tracking and a 4-week period preceding the stop in weight tracking. Additional mixed effects models investigated subsequent changes in physical activity data during 4 weeks of the 6-week long stop in weight tracking. Results People lost weight during continuous tracking (mean −0.47 kg, SD 1.73) but gained weight preceding the stop in weight tracking (mean 0.25 kg, SD 1.62; difference 0.71 kg; 95% CI 0.60 to 0.81). Average daily steps (beta=−220 daily steps per time period; 95% CI −320 to −120) and physical activity tracking frequency (beta=−3.4 days per time period; 95% CI −3.8 to −3.1) significantly declined from the continuous tracking to the pre-stop period. From pre-stop to post-stop, physical activity tracking frequency further decreased (beta=−6.6 days per time period; 95% CI −7.12 to −6.16), whereas daily step count on the day’s activity was measured increased (beta=110 daily steps per time period; 95% CI 50 to 170). Conclusions In the weeks before people stop tracking their weight, their physical activity and physical activity monitoring frequency decline. At the same time, weight increases, suggesting that declining motivation for weight control and difficulties with making use of negative weight feedback might explain why people stop tracking their weight. The increase in daily steps but decrease in physical activity tracking frequency post-stop might result from selective measurement of more active days.
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Affiliation(s)
- Kerstin Frie
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jamie Hartmann-Boyce
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan Jebb
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jason Oke
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Aveyard
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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19
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Phelan S, Halfman T, Pinto AM, Foster GD. Behavioral and Psychological Strategies of Long-Term Weight Loss Maintainers in a Widely Available Weight Management Program. Obesity (Silver Spring) 2020; 28:421-428. [PMID: 31970912 PMCID: PMC7003766 DOI: 10.1002/oby.22685] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/02/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study's purpose was to use validated questionnaires to identify novel behavioral and psychological strategies among weight loss maintainers (WLMs) in a commercial weight management program. METHODS Participants were 4,786 WLMs in WW (formerly Weight Watchers, New York, New York) who had maintained weight loss ≥ 9.1 kg (24.7 kg/23.8% weight loss on average) for 3.3 years and had a current mean BMI of 27.6 kg/m2 . A control group of 528 weight-stable individuals with obesity had a mean BMI of 38.9 kg/m2 and weight change < 2.3 kg over the previous 5 years. RESULTS WLMs versus Controls practiced more frequent healthy dietary choices (3.3 vs. 1.9; η p 2 = 0.37), self-monitoring (2.6 vs. 0.7; η p 2 = 0.30), and psychological coping (2.5 vs. 1.1; η p 2 = 0.25) strategies. WLMs also reported more willingness to ignore food cravings (4.4 vs. 3.5; η p 2 = 0.16) and had greater habit strength for healthy eating (5.3 vs. 3.2; η p 2 = 0.21). Standard canonical coefficients indicated that dietary (0.52), self-monitoring (0.40), and psychological (0.14) strategies as well as habit strength for healthy eating (0.15) contributed independently and most (49.5% of variance) to discriminating groups. CONCLUSIONS In a widely available weight management program, more frequent practice of healthy dietary, self-monitoring, and psychological coping strategies as well as development of greater habit strength for healthy eating differentiated long-term WLMs from weight-stable individuals with obesity.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology and Public Health & Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Tate Halfman
- Department of Kinesiology and Public Health & Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Angela Marinilli Pinto
- WW International, Inc.New YorkNew YorkUSA
- Psychology DepartmentBaruch CollegeCity University of New YorkNew YorkNew YorkUSA
| | - Gary D. Foster
- WW International, Inc.New YorkNew YorkUSA
- Center for Weight and Eating DisordersPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Duarte C, Gilbert P, Stalker C, Catarino F, Basran J, Scott S, Horgan G, Stubbs RJ. Effect of adding a compassion-focused intervention on emotion, eating and weight outcomes in a commercial weight management programme. J Health Psychol 2019; 26:1700-1715. [PMID: 31804147 DOI: 10.1177/1359105319890019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined whether adding a compassion-focused light touch digital intervention into a commercial multicomponent weight management programme improved eating behaviour, self-evaluation and weight-related outcomes. The compassion intervention significantly reduced binge eating symptomatology and dropout, and improved psychological adjustment and self-evaluation, but did not affect weight outcomes. Compassion, self-reassurance and reductions in shame and self-criticism mediated the effect of the intervention on reductions of binge eating symptomatology. Negative self-evaluation, binge eating symptomatology, susceptibility to hunger and eating guilt were significant predictors of dropout. Findings suggest that compassion-based digital tools may help participants better manage binge eating symptomatology and self-evaluation in weight management interventions.
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21
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Stamp E, Crust L, Swann C. Mental toughness and dietary behaviours in undergraduate university students. Appetite 2019; 142:104389. [PMID: 31376439 DOI: 10.1016/j.appet.2019.104389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 11/26/2022]
Abstract
Dietary behaviour of university students is a growing concern and a potential contributor to weight gain during university studies. Individual differences may be one factor that influences how students respond and adapt when entering a new environment. Mental toughness (MT) is an individual difference which has previously been found to be significantly and positively related to health behaviours (e.g., physical activity, psychological wellbeing), thus it was hypothesised that MT would predict eating behaviours of university students. Undergraduate students (n = 167) completed an online questionnaire to assess MT and eating behaviours. Students were included from all three years of undergraduate study and from a range of courses at nine UK institutions. Pearson correlations were conducted between MT variables and eating behaviour variables. The MT component life control displayed the strongest relationship with healthy eating (r = 0.24, p < .001). Regression analysis found weak relationships between the components of MT that were related to eating behaviours. Thus, factors other than MT may play a greater role influencing eating behaviours of university students. It may be that MT is more important in adhering to programmes to change dietary behvaiours, rather than simply eating healthily.
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Affiliation(s)
| | - Lee Crust
- University of Lincoln, Brayford Way, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Christian Swann
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, Australia; Centre for Athlete Development, Experience & Performance, Southern Cross University, Coffs Harbour, Australia
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22
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Daley A, Jolly K, Madigan C, Griffin R, Roalfe A, Lewis A, Nickless A, Aveyard P. A brief behavioural intervention to promote regular self-weighing to prevent weight regain after weight loss: a RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAlthough behavioural weight loss treatments can be effective, long-term maintenance of this weight loss remains a critical challenge because the vast majority of people will regain their lost weight over time. The period after initial weight loss is the time when people are at the highest risk of weight regain.ObjectiveThe primary aim of this study was to evaluate the effectiveness and cost-effectiveness of a brief behavioural intervention delivered by non-specialist call centre staff to promote regular self-weighing to prevent weight regain after intentional weight loss.DesignRandomised controlled trial.SettingWest Midlands, UK.ParticipantsAdults were recruited if they had attended a local authority-funded weight management programme and had lost ≥ 5% of their starting weight by the end of their weight loss programme.InterventionsThe intervention group received three brief support telephone calls, delivered by non-specialist call centre staff (from a third-sector community organisation), that encouraged setting a weight maintenance target of ≤ 1 kg of weight gain from current weight, which was to be assessed by daily self-weighing and recording weight on a record card, together with regular text messages. Participants were asked to return to their weight loss plan if they gained > 1 kg above their target weight. The usual-care group received a standard weight maintenance leaflet, the infographic EatWell Plate and a list of useful websites pertaining to weight management.Main outcome measuresThe primary outcome was the difference between the groups in mean weight change (kg) from baseline to 12 months. The secondary outcomes included the proportion of participants in each group who had regained < 1 kg in weight at the 3- and 12-month follow-up points.ResultsA total of 813 potential participants were screened, 583 of whom were eligible and randomised (usual care,n = 292; intervention,n = 291). A total of 94% and 89% of participants completed follow-up at 3 and 12 months, respectively. At 12 months, the mean unadjusted weight change was +0.39 kg for the intervention group and –0.17 kg for the usual-care group, an adjusted difference of 0.53 kg [95% confidence interval (CI) –0.64 to 1.71 kg]. At 12 months, 134 (45.9%) and 130 (44.7%) participants regained ≤ 1 kg of their baseline weight in the usual-care and intervention groups, respectively (odds ratio 0.96, 95% CI 0.69 to 1.33). As the intervention was ineffective, we did not pursue a cost-effectiveness analysis.ConclusionsBrief behavioural telephone support delivered by non-specialist workers to promote target-setting and daily self-weighing and recording of weight does not prevent weight regain after intentional weight loss. Specifically, as target-setting and daily self-weighing did not increase conscious cognitive restraint, people may need more intensive interventions to promote the use of behavioural techniques that help people maintain lost weight.Trial registrationCurrent Controlled Trials ISRCTN52341938.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 7, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amanda Daley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Claire Madigan
- Primary Care Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Ryan Griffin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrea Roalfe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amanda Lewis
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Alecia Nickless
- Primary Care Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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23
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Kwasnicka D, Dombrowski SU, White M, Sniehotta FF. 'It's not a diet, it's a lifestyle': a longitudinal, data-prompted interview study of weight loss maintenance. Psychol Health 2019; 34:963-982. [PMID: 30905184 DOI: 10.1080/08870446.2019.1579913] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To advance understanding of the individual and environmental factors underpinning weight loss maintenance. Design: Semi-structured, data-prompted interviews were conducted with twelve overweight adult participants (three men, nine women) who had lost over 5% of their body weight in the year before baseline. Participants gathered daily data through wireless scales, activity monitors (Fitbit™), ecological momentary assessment and experience sampling (taking photographs, writing notes). They were interviewed at 3- and 6-months post baseline. Interview stimuli included personal data of weight and activity graphs, correlations of psychological factors, and self-generated notes and photographs. Interview data were analysed using the Framework Method, applying pre-specified maintenance-relevant theoretical themes. Results: The theoretical Framework provided a good fit for the narratives, with five main themes underpinning successful weight loss maintenance: sustained motivation, effective self-regulation, plentiful resources, habit formation and a supportive environment. Additionally, participants reported an identity shift from being a dieter to accepting a new healthy lifestyle. Goal prioritising and allowing for occasional controlled lapses enhanced weight loss maintenance. Conclusions: This study successfully used the novel method of data-prompted interviews to explore weight loss maintenance experiences with new explanations emerging from the data. Future research should further develop behaviour change maintenance theory and data-prompted interview method.
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Affiliation(s)
- Dominika Kwasnicka
- a School of Psychology , Curtin University , Perth , Australia.,b SWPS University of Social Sciences and Humanities , Wroclaw , Poland.,c Institute of Health and Society , Newcastle University, Newcastle upon Tyne, and Fuse, UKCRC Centre for Translational Research in Public Health , Newcastle , UK
| | - Stephan U Dombrowski
- c Institute of Health and Society , Newcastle University, Newcastle upon Tyne, and Fuse, UKCRC Centre for Translational Research in Public Health , Newcastle , UK.,d Faculty of Kinesiology , University of New Brunswick , Fredericton , NB , Canada
| | - Martin White
- c Institute of Health and Society , Newcastle University, Newcastle upon Tyne, and Fuse, UKCRC Centre for Translational Research in Public Health , Newcastle , UK.,e UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit , School of Clinical Medicine, University of Cambridge , Cambridge , UK
| | - Falko F Sniehotta
- c Institute of Health and Society , Newcastle University, Newcastle upon Tyne, and Fuse, UKCRC Centre for Translational Research in Public Health , Newcastle , UK
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Hartmann-Boyce J, Boylan AM, Jebb SA, Aveyard P. Experiences of Self-Monitoring in Self-Directed Weight Loss and Weight Loss Maintenance: Systematic Review of Qualitative Studies. QUALITATIVE HEALTH RESEARCH 2019; 29:124-134. [PMID: 29984630 DOI: 10.1177/1049732318784815] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The experience and role of self-monitoring in self-directed weight loss attempts may be distinctly different from that within formal interventions, and has yet to be fully explored. We systematically reviewed qualitative studies to examine experiences of self-monitoring as an aid to self-directed weight loss. Thematic synthesis was used to construct descriptive and analytical themes from the available data. In all, 22 studies (681 participants) were included, in which the uses of self-monitoring ranged from an aid to increase adherence to a tool for facilitating analysis. Self-monitoring also influenced and was influenced by self-perception and emotions. Feelings of shame were linked with abandonment of efforts. Findings highlight the centrality of interpretation of self-monitored data, the implications this interpretation has on sense of self, and the impact of broader discourses. Explicitly framing self-monitoring as a positive tool with which to aid analysis may encourage helpful use of this technique.
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Versteegden DPA, Van Himbeeck MJJ, Nienhuijs SW. Assessing the value of eHealth for bariatric surgery (BePatient trial): study protocol for a randomized controlled trial. Trials 2018; 19:625. [PMID: 30428902 PMCID: PMC6237032 DOI: 10.1186/s13063-018-3020-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 10/25/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The expansion of digital devices and widespread access to the Internet has opened up opportunities to provide patients with more personal information. It can be hypothesized that eHealth in addition to standard care could enhance clinical outcomes such as increased weight loss, co-morbidity reduction, and commitment to the program. The beneficial value of incorporating eHealth applications as standard postoperative care is yet to be established. In this trial, the value of different levels of eHealth are assessed. METHODS/DESIGN Two hundred adult patients with a body mass index (BMI) ≥ 40 kg/m2, or ≥ 35 kg/m2 with obesity-related co-morbidity, undergoing sleeve gastrectomy or gastric bypass will be enrolled in this randomized controlled trial. Patients will be randomly assigned to one of the groups: receiving standard care (control group, n = 100); have access to an online eHealth platform in addition to the previous group (online group, n = 50); or receive wireless monitoring devices in addition to previous groups (device group, n = 50). The total follow-up period is two years postoperatively. Primary outcome is weight loss in terms of BMI. Secondary outcomes include: quality of life; return-to-work time; co-morbidity reduction; additional contacts; and ease of use of devices. DISCUSSION In this trial, the value of different levels of eHealth will be assessed. This addresses an important aspect of a changing healthcare environment. TRIAL REGISTRATION Trialregister.nl, NTR6827. Retrospectively registered on 19 November 2017. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6827 .
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Affiliation(s)
- Dirk P A Versteegden
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands.
| | - Magaly J J Van Himbeeck
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
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Ntoumanis N, Sedikides C. Holding on to the Goal or Letting It Go and Moving On? A Tripartite Model of Goal Striving. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2018. [DOI: 10.1177/0963721418770455] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent findings challenge the widely held motto of “never give up” in goal striving. There are situations in which it is of strategic interest to abandon an important goal and allocate resources to an alternative goal. The ability to realize whether a goal is attainable or not (and therefore the ability to make the “right choice” between goal persistence and goal disengagement or reengagement) is influenced by at least two key motivational factors: motivation for goal striving and a self-regulatory technique called mental contrasting with implementation intentions. The interplay between these two factors is as yet unexplored but holds promise for several conceptual and practical advancements in understanding the pursuit of challenging life goals. To this end, we propose a tripartite model of goal striving that integrates goal motivation and goal regulation.
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Raffoul A, Leatherdale ST, Kirkpatrick SI. Weight Management, Weight Perceptions, and Health-Compromising Behaviours Among Adolescent Girls in the COMPASS Study. J Prim Prev 2018; 39:345-360. [DOI: 10.1007/s10935-018-0512-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hartmann-Boyce J, Nourse R, Boylan AM, Jebb SA, Aveyard P. Experiences of Reframing during Self-Directed Weight Loss and Weight Loss Maintenance: Systematic Review of Qualitative Studies. Appl Psychol Health Well Being 2018; 10:309-329. [PMID: 29856139 PMCID: PMC6055795 DOI: 10.1111/aphw.12132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Reframing means changing the way that a person thinks or feels about a weight loss attempt or weight loss maintenance to enhance its experience or facilitate its success. Although participants have described this, it has not been explored in the academic literature. Here, we set out to systematically review qualitative studies to examine the ways in which people use and experience reframing in self‐directed weight loss. Methods Seven electronic databases were searched to January 2017 for qualitative studies of adults with overweight or obesity attempting to lose weight or maintain weight loss through self‐directed behavior change. Studies must have contained some information pertinent to reframing. Thematic synthesis was used to identify descriptive and analytical themes from the available data. Results We included 23 studies, representing 723 participants. No study focused specifically on reframing. Most studies involved people who had tried to lose weight previously. In the most common examples of reframing, participants spoke of construing previous weight management attempts as “dieting”, whereas in current attempts they used reframing to move away from this concept. Participants spoke of finding reframing helpful because it removed the sense of depriving themselves and instead allowed them to construe the food choices as healthful. Likewise, the language of dieting created a sense of temporary effort, while construing this as a way of life allowed continuation of conscious control over energy balance without the feeling of undue effort. In some cases, these changes were bolstered by change in self‐identity. Conclusions Some people construe deliberate weight loss as a form of deprivation and cognitively reframe to avoid the negative emotions this creates and to prevent relapse. Reframing the dietary regimen as about healthy eating and a new way of life made weight control seem less burdensome for these participants and they felt able to maintain their efforts.
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Ingels JS, Zizzi S. A qualitative analysis of the role of emotions in different patterns of long-term weight loss. Psychol Health 2018; 33:1014-1027. [PMID: 29616591 DOI: 10.1080/08870446.2018.1453511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To explore participant perspectives of the impact emotions have on weight loss. DESIGN A qualitative design gathered data through semi-structured interviews with participants in a weight management programme. The interview addresses the following research questions: (1) how do individuals working to lose weight perceive the impact emotions have on their long-term success, and (2) what strategies do more or less successful participants use to regulate their emotions? Researchers conducted and transcribed the interviews then completed content analysis to create and organise themes. RESULTS Two broad themes emerged through the interviews with 21 participants: emotional impact and emotional regulation. Further subthemes captured emotions blocking action toward goals, strategies for regulating emotions (e.g. exercise, food) and the need for new strategies to regulate emotions. Themes were also split in to three groups based on weight outcomes: regainer, moderate success (3-6% loss) and large success (>7% loss). More successful participants, compared to regainers, shared being aware of the impact of their emotions and made efforts to develop healthy regulation strategies. CONCLUSIONS Emotional awareness and regulation play an important role in participant's weight management experience. Taking time to build emotional awareness and strategies to manage emotions is important to participants in weight management.
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Affiliation(s)
- John Spencer Ingels
- a Sport and Exercise Psychology, College of Physical Activity and Sport Sciences , West Virginia University , Morgantown , WV , USA
| | - Sam Zizzi
- b College of Physical Activity and Sport Sciences , West Virginia University , Morgantown , WV , USA
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Liu S, Willoughby JF. Do Fitness Apps Need Text Reminders? An Experiment Testing Goal-Setting Text Message Reminders to Promote Self-Monitoring. JOURNAL OF HEALTH COMMUNICATION 2018; 23:379-386. [PMID: 29601270 DOI: 10.1080/10810730.2018.1455768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Fitness tracking apps have the potential to change unhealthy lifestyles, but users' lack of compliance is an issue. The current intervention examined the effectiveness of using goal-setting theory-based text message reminders to promote tracking activities on fitness apps. We conducted a 2-week experiment with pre- and post-tests with young adults (n = 50). Participants were randomly assigned to two groups-a goal-setting text message reminder group and a generic text message reminder group. Participants were asked to use a fitness tracking app to log physical activity and diet for the duration of the study. Participants who received goal-setting reminders logged significantly more physical activities than those who only received generic reminders. Further, participants who received goal-setting reminders liked the messages and showed significantly increased self-efficacy, awareness of personal goals, motivation, and intention to use the app. The study shows that incorporating goal-setting theory-based text message reminders can be useful to boost user compliance with self-monitoring fitness apps by reinforcing users' personal goals and enhancing cognitive factors associated with health behavior change.
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Affiliation(s)
- Shuang Liu
- a The Edward R Murrow College of Communication , Washington State University , Pullman , USA
| | - Jessica F Willoughby
- a The Edward R Murrow College of Communication , Washington State University , Pullman , USA
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Greaves C, Poltawski L, Garside R, Briscoe S. Understanding the challenge of weight loss maintenance: a systematic review and synthesis of qualitative research on weight loss maintenance. Health Psychol Rev 2017; 11:145-163. [DOI: 10.1080/17437199.2017.1299583] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Colin Greaves
- Collaboration for Academic Primary Care, University of Exeter Medical School, Exeter, UK
| | - Leon Poltawski
- Collaboration for Academic Primary Care, University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - Simon Briscoe
- Peninsula Technology Assessment Group, University of Exeter Medical School, Exeter, UK
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Hartmann-Boyce J, Boylan AM, Jebb SA, Fletcher B, Aveyard P. Cognitive and behavioural strategies for self-directed weight loss: systematic review of qualitative studies. Obes Rev 2017; 18:335-349. [PMID: 28117945 PMCID: PMC5408390 DOI: 10.1111/obr.12500] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/06/2016] [Indexed: 12/23/2022]
Abstract
AIM We conducted a systematic review of qualitative studies to examine the strategies people employ as part of self-directed weight loss attempts, map these to an existing behaviour change taxonomy and explore attitudes and beliefs surrounding these strategies. METHODS Seven electronic databases were searched in December 2015 for qualitative studies in overweight and obese adults attempting to lose weight through behaviour change. We were interested in strategies used by participants in self-directed efforts to lose weight. Two reviewers extracted data from included studies. Thematic and narrative synthesis techniques were used. RESULTS Thirty one studies, representing over 1,000 participants, were included. Quality of the included studies was mixed. The most commonly covered types of strategies were restrictions, self-monitoring, scheduling, professional support and weight management aids. With the exception of scheduling, for which participant experiences were predominantly positive, participants' attitudes and beliefs surrounding implementation of these groups of strategies were mixed. Two new groups of strategies were added to the existing taxonomy: reframing and self-experimentation. CONCLUSIONS This review demonstrates that at present, interventions targeting individuals engaged in self-management of weight do not necessarily reflect lived experiences of self-directed weight loss.
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Affiliation(s)
- J Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A-M Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - B Fletcher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Kruseman M, Schmutz N, Carrard I. Long-Term Weight Maintenance Strategies Are Experienced as a Burden by Persons Who Have Lost Weight Compared to Persons with a lifetime Normal, Stable Weight. Obes Facts 2017; 10:373-385. [PMID: 28810238 PMCID: PMC5644938 DOI: 10.1159/000478096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 06/07/2017] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To assess dietary intake, eating patterns, physical activity and eating behaviors, and to explore strategies and perceptions of the experience of weight maintenance in weight loss maintainers (weight loss maintenance (WLM) ≥ 10% weight loss maintained for ≥1 year) and in matched controls with a lifetime stable normal weight. METHODS Volunteers (32) were recruited by a snowball procedure in this cross-sectional, mixed-methods study. Diet, physical activity, and eating behaviors were assessed with validated questionnaires. Strategies and experiences were investigated during interviews. Descriptive coding, thematic analysis (qualitative data) as well as descriptive analysis and t-tests (quantitative data) were performed. RESULTS Both groups had similar energy and macronutrient consumption. Those in the WLM group reported higher levels of exercise and scored higher on several dimensions of eating disorders. Four themes - 'food choices,' 'quantities and portion control,' 'physical activity', and 'burden' - emerged from the qualitative data. Both groups used similar weight maintenance strategies, but those in the WLM group experienced a higher burden, expressing effortful control which contrasted with the control group's confidence in their internal cues. CONCLUSION Our results show an additional burden related with maintaining weight loss compared to keeping a stable normal weight. They provide evidence to devise interventions that will address the difficulty of regulating intake.
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Affiliation(s)
- Maaike Kruseman
- *Prof. Dr. Maaike Kruseman, Department of Nutrition and Dietetics, HES-SO University of Applied Sciences Western Switzerland, Rue des Caroubiers 25, 1227 Carouge, Switzerland,
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Does the Framing of Progress Towards Virtual Rewards Matter? BUSINESS & INFORMATION SYSTEMS ENGINEERING 2016. [DOI: 10.1007/s12599-016-0441-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Qualitative analysis of the role of self-weighing as a strategy of weight control for weight-loss maintainers in comparison with a normal, stable weight group. Appetite 2016; 105:604-10. [PMID: 27374738 DOI: 10.1016/j.appet.2016.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 11/20/2022]
Abstract
Self-weighing seems to have a primary role in weight-loss maintenance. The use of this strategy may help correct even slight weight regain and contribute to long-term weight stability. However, self-weighing has also been associated with negative psychological health consequences in specific subgroups. This study aimed to explore the use and the behavioral and psychological consequences of self-weighing in a group of weight-loss maintainers (WLoMs). We chose a qualitative design to conduct this investigation. Eighteen WLoMs were interviewed and compared to a matched comparison group of 18 participants with a lifelong normal stable weight (NSW). Analyses showed that most WLoMs needed regular self-weighing to be aware of their weight. The weight displayed on the scale helped WLoMs sustain the continuous efforts needed to maintain weight loss and also at times triggered corrective actions that were sometimes drastic. Weight changes generated both negative and positive affect among WLoMs, who could experience anxiety because of self-weighing or have their self-esteem impaired in the case of weight gain. In comparison, the NSW group rarely used self-weighing. They relied on a conscious way of living to control their weight and needed fewer strategies. NSW participants simply went back to their routine when they felt a slight increase in their weight, without experiencing consequences on their mood or self-esteem. Regular self-weighing as a component of weight-loss maintenance should be encouraged to help WLoMs regulate their food and physical activity, provided that potential consequences on psychological well-being, including self-esteem, are screened and addressed when needed.
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Rogerson D, Soltani H, Copeland R. The weight-loss experience: a qualitative exploration. BMC Public Health 2016; 16:371. [PMID: 27142984 PMCID: PMC4855339 DOI: 10.1186/s12889-016-3045-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/28/2016] [Indexed: 11/23/2022] Open
Abstract
Background Long-term weight management consists of weight-loss, weight-loss maintenance, and weight-gain stages. Qualitative insights into weight management are now appearing in the literature however research appears to be biased towards explorations of weight-loss maintenance. The qualitative understanding of weight loss, which begets weight-loss maintenance and might establish the experiences and behaviours necessary for successful long-term weight management, is comparatively under-investigated. The aim of this study was to investigate the weight-loss experiences of a sample of participants not aligned to clinical intervention research, in order to understand the weight-loss experiences of a naturalistic sample. Methods Participants (n = 8) with weight-loss (n = 4) and weight-maintenance experiences (n = 4) were interviewed using a semi-structured interview to understand the weight-loss experience. Interview data was analysed thematically using Framework Analysis and was underpinned by realist meta-theory. Results Weight loss was experienced as an enduring challenge, where factors that assisted weight loss were developed and experienced dichotomously to factors that hindered it. Participants described barriers to (dichotomous thinking, environments, social pressures and weight centeredness) and facilitators of (mindfulness, knowledge, exercise, readiness to change, structure, self-monitoring and social support) their weight-loss goals in rich detail, highlighting that weight loss was a complex experience. Conclusions Weight loss was a difficult task, with physical, social, behavioural and environmental elements that appeared to assist and inhibit weight-loss efforts concurrently. Health professionals might need to better understand the day-to-day challenges of dieters in order to provide more effective, tailored treatments. Future research should look to investigate the psycho-social consequences of weight-loss dieting, in particular self-imposed social exclusion and spousal sabotage and flexible approaches to treatment.
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Affiliation(s)
- David Rogerson
- Academy of Sport and Physical Activity, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, S10 2BP, UK.
| | - Hora Soltani
- Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, S10 2BP, UK
| | - Robert Copeland
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, S10 2BP, UK
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Simpson SA, McNamara R, Shaw C, Kelson M, Moriarty Y, Randell E, Cohen D, Alam MF, Copeland L, Duncan D, Espinasse A, Gillespie D, Hill A, Owen-Jones E, Tapper K, Townson J, Williams S, Hood K. A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults. Health Technol Assess 2016; 19:v-vi, xix-xxv, 1-378. [PMID: 26168409 DOI: 10.3310/hta19500] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obesity has significant health and NHS cost implications. Relatively small reductions in weight have clinically important benefits, but long-term weight loss maintenance (WLM) is challenging. Behaviour change interventions have been identified as key for WLM. Motivation is crucial to supporting behaviour change, and motivational interviewing (MI) has been identified as a successful approach to changing health behaviours. The study was designed as an adequately powered, pragmatic randomised controlled trial (RCT); however, owing to recruitment issues, the study became a feasibility trial. OBJECTIVES To assess recruitment, retention, feasibility, acceptability, compliance and delivery of a 12-month intervention to support WLM. Secondary objectives were to assess the impact of the intervention on body mass index (BMI) and other secondary outcomes. DESIGN Three-arm individually randomised controlled trial comprising an intensive arm, a less intensive arm and a control arm. SETTING Community setting in South Wales and the East Midlands. PARTICIPANTS Individuals aged 18-70 years with a current or previous BMI of ≥ 30 kg/m(2) who could provide evidence of at least 5% weight loss during the previous 12 months. INTERVENTION Participants received individually tailored MI, which included planning and self-monitoring. The intensive arm received six face-to-face sessions followed by nine telephone sessions. The less intensive arm received two face-to-face sessions followed by two telephone sessions. The control arm received a leaflet advising them on healthy lifestyle. MAIN OUTCOME MEASURES Feasibility outcomes included numbers recruited, retention and adherence. The primary effectiveness outcome was BMI at 12 months post randomisation. Secondary outcomes included waist circumference, waist-to-hip ratio, physical activity, proportion maintaining weight loss, diet, quality of life, health service resource usage, binge eating and well-being. A process evaluation assessed intervention delivery, adherence, and participants' and practitioners' views. Economic analysis aimed to assess cost-effectiveness in terms of quality-adjusted life-years (QALYs). RESULTS A total of 170 participants were randomised. Retention was good (84%) and adherence was excellent (intensive, 83%; less intensive, 91%). The between-group difference in mean BMI indicated the intensive arm had BMIs 1.0 kg/m(2) lower than the controls [95% confidence interval (CI) -2.2 kg/m(2) to 0.2 kg/m(2)]. Similarly, a potential difference was found in weight (average difference of 2.8 kg, 95% CI -6.1 kg to 0.5 kg). The intensive arm had odds of maintaining on average 43% [odds ratio(OR) 1.4, 95% CI 0.6 to 3.5] higher than controls. None of these findings were statistically significant. Further analyses controlling for level of adherence indicated that average BMI was 1.2 kg/m(2) lower in the intensive arm than the control arm (95% CI -2.5 kg/m(2) to 0.0 kg/m(2)). The intensive intervention led to a statistically significant difference in weight (mean -3.7 kg, 95% CI -7.1 kg to -0.3 kg). The other secondary outcomes showed limited evidence of differences between groups. The intervention was delivered as planned, and both practitioners and participants were positive about the intervention and its impact. Although not powered to assess cost-effectiveness, results of this feasibility study suggest that neither intervention as currently delivered is likely to be cost-effective in routine practice. CONCLUSION This is the first trial of an intervention for WLM in the UK, the intervention is feasible and acceptable, and retention and adherence were high. The main effectiveness outcome showed a promising mean difference in the intensive arm. Owing to the small sample size, we are limited in the conclusions we can draw. However, findings suggest that the intensive intervention may facilitate long-term weight maintenance and, therefore, further testing in an effectiveness trial may be indicated. Research examining WLM is in its infancy, further research is needed to develop our understanding of WLM and to expand theory to inform the development of interventions to be tested in rigorously designed RCTs with cost-effectiveness assessed. TRIAL REGISTRATION Current Controlled Trials ISRCTN35774128. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sharon A Simpson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel McNamara
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Christine Shaw
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Mark Kelson
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Yvonne Moriarty
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | | | - David Cohen
- Faculty of Health Sport and Science, University of South Wales, Pontypridd, UK
| | - M Fasihul Alam
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Lauren Copeland
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Donna Duncan
- Abertawe Bro Morgannwg University Health Board, Bridgend, UK
| | - Aude Espinasse
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - David Gillespie
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Andy Hill
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, Leeds, UK
| | | | - Katy Tapper
- Department of Psychology, City University, London, UK
| | - Julia Townson
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
| | - Simon Williams
- Sport, Health and Exercise Science Research Unit, University of South Wales, Pontypridd, UK
| | - Kerry Hood
- South East Wales Trial Unit, Cardiff University, Cardiff, UK
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Reed JR, Yates BC, Houfek J, Pullen CH, Briner W, Schmid KK. Eating Self-Regulation in Overweight and Obese Adults: A Concept Analysis. Nurs Forum 2016; 51:105-116. [PMID: 25611400 DOI: 10.1111/nuf.12125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Poor eating behaviors greatly influence the development of becoming overweight or obese. Learning to better self-regulate eating is one area in which individuals can positively influence their own health. PURPOSE The purpose of this concept analysis is to provide an in-depth analysis of the concept eating self-regulation as it pertains to overweight and obese adults using Walker and Avant's method. RESULTS The definition for eating self-regulation formulated as a result of this concept analysis and based on the critical attributes is the ability to initiate goal-related behaviors, to consistently self-monitor dietary intake, to regularly apply willpower to resist temptations, to self-evaluate where one stands in relationship to goal attainment, and finally to maintain motivation to positively change eating behaviors. Cognitive restraint, moderation, mindfulness, disinhibition, delayed gratification, emotions and moods, self-efficacy, social support, the environment, and physical activity are the antecedents that may influence eating self-regulation. CONCLUSION Examining an individual's weight, body mass index, lipid levels, or blood pressure are some ways to determine if self-regulation of eating behavior is achieved. With a consistent definition of self-regulation and a better understanding of the critical factors that influence eating behaviors, research can better explore how to help individuals change their eating behaviors more effectively.
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Affiliation(s)
- Jill R Reed
- College of Nursing, University of Nebraska Medical Center, Kearney, NE
| | - Bernice C Yates
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Julia Houfek
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Carol H Pullen
- College of Nursing, University of Nebraska Medical Center, Omaha, NE
| | - Wayne Briner
- Department of Psychology, Ashford University, San Diego, CA
| | - Kendra K Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
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Annesi JJ, Johnson PH, Tennant GA, Porter KJ, Mcewen KL. Weight Loss and the Prevention of Weight Regain: Evaluation of a Treatment Model of Exercise Self-Regulation Generalizing to Controlled Eating. Perm J 2016; 20:15-146. [PMID: 26901268 DOI: 10.7812/tpp/15-146] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT For decades, behavioral weight-loss treatments have been unsuccessful beyond the short term. Development and testing of innovative, theoretically based methods that depart from current failed practices is a priority for behavioral medicine. OBJECTIVE To evaluate a new, theory-based protocol in which exercise support methods are employed to facilitate improvements in psychosocial predictors of controlled eating and sustained weight loss. METHODS Women with obesity were randomized into either a comparison treatment that incorporated a print manual plus telephone follow-ups (n = 55) or an experimental treatment of The Coach Approach exercise-support protocol followed after 2 months by group nutrition sessions focused on generalizing self-regulatory skills from an exercise support to a controlled eating context (n = 55). Repeated-measures analysis of variance contrasted group changes in weight, physical activity, fruit and vegetable intake, mood, and exercise- and eating-related self-regulation and self-efficacy over 24 months. Regression analyses determined salient interrelations of change scores over both the weight-loss phase (baseline-month 6) and weight-loss maintenance phase (month 6-month 24). RESULTS Improvements in all psychological measures, physical activity, and fruit and vegetable intake were significantly greater in the experimental group where a mean weight loss of 5.7 kg (6.1% of initial body weight) occurred at month 6, and was largely maintained at a loss of 5.1 kg (5.4%) through the full 24 months of the study. After establishing temporal intervals for changes in self-regulation, self-efficacy, and mood that best predicted improvements in physical activity and eating, a consolidated multiple mediation model suggested that change in self-regulation best predicted weight loss, whereas change in self-efficacy best predicted maintenance of lost weight. CONCLUSIONS Because for most participants loss of weight remained greater than that required for health benefits, and costs for treatment administration were comparatively low, the experimental protocol was considered successful. After sufficient replication, physician referral and applications within health promotion and wellness settings should be considered.
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Affiliation(s)
- James J Annesi
- Director of Wellness Advancement, YMCA of Metropolitan Atlanta, and Professor in the Department of Health Promotion and Physical Education at Kennesaw State University in GA.
| | - Ping H Johnson
- Professor in the Department of Health Promotion and Physical Education at Kennesaw State University in GA.
| | | | - Kandice J Porter
- Associate Professor in the Department of Health Promotion and Physical Education at Kennesaw State University in GA.
| | - Kristin L Mcewen
- Empower Healthy Living Lead at the YMCA of Metropolitan Atlanta in GA.
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Stubbs RJ, Morris L, Pallister C, Horgan G, Lavin JH. Weight outcomes audit in 1.3 million adults during their first 3 months' attendance in a commercial weight management programme. BMC Public Health 2015; 15:882. [PMID: 26359180 PMCID: PMC4566482 DOI: 10.1186/s12889-015-2225-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 09/04/2015] [Indexed: 01/07/2023] Open
Abstract
Background Over sixty percent of adults in the UK are now overweight/obese. Weight management on a national scale requires behavioural and lifestyle solutions that are accessible to large numbers of people. Evidence suggests commercial weight management programmes help people manage their weight but there is little research examining those that pay to attend such programmes rather than being referred by primary care. The objective of this analysis was to evaluate the effectiveness of a UK commercial weight management programme in self-referred, fee-paying participants. Methods Electronic weekly weight records were collated for self-referred, fee-paying participants of Slimming World groups joining between January 2010 and April 2012. This analysis reports weight outcomes in 1,356,105 adult, non-pregnant participants during their first 3 months’ attendance. Data were analysed by regression, ANOVA and for binomial outcomes, chi-squared tests using the R statistical program. Results Mean (SD) age was 42.3 (13.6) years, height 1.65 m (0.08) and start weight was 88.4 kg (18.8). Mean start BMI was 32.6 kg/m2 (6.3 kg/m2) and 5 % of participants were men. Mean weight change of all participants was −3.9 kg (3.6), percent weight change −4.4 (3.8), and BMI change was −1.4 kg/m2 (1.3). Mean attendance was 7.8 (4.3) sessions in their first 3 months. For participants attending at least 75 % of possible weekly sessions (n = 478,772), mean BMI change was −2.5 kg/m2 (1.3), weight change −6.8 kg (3.7) and percent weight change −7.5 % (3.5). Weight loss was greater in men than women absolutely (−6.5 (5.3) kg vs −3.8 (3.4) kg) and as a percentage (5.7 % (4.4) vs 4.3 % (3.7)), respectively. All comparisons were significant (p < 0.001). Level of attendance and percent weight loss in the first week of attendance together accounted for 55 % of the variability in weight lost during the study period. Conclusions A large-scale commercial lifestyle-based weight management programme had a significant impact on weight loss outcomes over 3 months. Higher levels of attendance led to levels of weight loss known to be associated with significant clinical benefits, which on this scale may have an impact on public health.
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Affiliation(s)
- R James Stubbs
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK. .,College of Life and Natural Sciences, University of Derby, Kedleston Road, Derby, DE22 1GB, UK.
| | - Liam Morris
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK.
| | - Carolyn Pallister
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK.
| | - Graham Horgan
- Biomathematics and Statistics Scotland, The Rowett Institute of Nutrition and Health, Greenburn road, Aberdeen, AB21 9SB, UK.
| | - Jacquie H Lavin
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK.
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Keller C, Siegrist M. The weight management strategies inventory (WMSI). Development of a new measurement instrument, construct validation, and association with dieting success. Appetite 2015; 92:322-36. [DOI: 10.1016/j.appet.2015.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/12/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
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