Motivations for participation in weight loss clinical trials

Males are under-represented in weight loss clinical trials, usually comprising fewer than one-quarter of participants. Our study aimed to investigate people's motivations for participating in weight loss trials and determine any relationship with gender. Eighty individuals from an existing registry for weight loss trials were contacted, of whom 24 (9 males, 15 females) agreed to participate in a 20-min semi-structured interview around their expectations and motivations for volunteering. Interviews were audio-recorded and transcribed in Zoom. A transcript of each interview was uploaded into NVivo for preliminary thematic analysis. Improved health was a common motivation for pursuing weight loss in all subjects regardless of gender. Male recruitment to weight loss trials was often influenced by advice from a healthcare professional to lose weight for the prevention of obesity-related comorbidities, whereas family and aesthetic expectations (e.g., clothes and fashion) were key elements of female participation. Identification of gender differences in motivations for volunteering in weight loss trials will help improve tailoring of recruitment strategies and interventions to enhance male participation in the future.

"I didn't want to do it on my own": A qualitative study of women's perceptions of facilitating and risk factors for weight control on a UK commercial community program

Overweight and obesity remain serious public health concerns. Outcomes from community based commercial weight management programmes vary, relapse is common and drop out is high. Outcomes could be improved by better understanding experiences on these programmes. The aim of our study was to generate accounts of people's experience on a commercial weight-management program to identify what experiences were perceived as facilitating, and what posed risks, to programme effectiveness and compliance. We conducted individual, semi-structured interviews with eighteen Caucasian women (mean age 45.4y) who were members of nation-wide UK commercial, fee-paying, community weight management programme. Interview data was analysed via framework analysis. Participants' experiences indicated that the programme helped by triggering several intra- and interpersonal processes that catalysed change across psychological, physiological, dietary and behavioural areas of their life. Risks to program adherence and effectiveness spanned well-known risks such as self-regulation fatigue and the difficulty of recovering from negative self-criticism, as well as new factors such as the confusing nature of weight change, the relatively powerful impact of everyday events, and the difficulty in getting the balance right between personalised support vs. intrusion. The complexity of reported experiences challenges the linear, predictive pathways of change proposed by many health behaviour models of weight management. To improve effectiveness, programmes need to go well beyond behavioural and dietary support. It is recommended that community, commercial programmes educate people about the physiological and psychological tensions they will encounter, why people lose weight at different rates, the likelihood of weight relapse and strategies to manage these, including evidence-based support for managing self-criticism.

The dynamics of decision-making in weight loss and maintenance: a qualitative enquiry

Background

Behavioural approaches to weight loss are often initially successful but less so in the longer term, as some people maintain the necessary behaviour changes while others do not. This study aimed to derive possible explanations for this using a qualitative approach with a view to improving intervention effectiveness.

Methods

Thirty-six participants in a development and feasibility study for a weight loss and maintenance intervention (called SkiM) were interviewed three times over 18 months regarding their experiences before, during and after the intervention. Data were analysed thematically. The accounts of those who were more and less successful in terms of longer term weight loss were compared, and a conceptual model linking the main analytic themes was developed.

Results

Five interpretative themes were generated: encountering and managing key situations; the impact of emotion; the source of control; personal values; and acquiring knowledge and skills. These themes were linked through a model of decision-making during key situations. In this model, behavioural decisions emerge from a dynamic interplay between several drivers: emotional state and needs, perceived control, personal values, the individual’s knowledge and skills, and their existing habits. The individual’s response in key situations generates experiential learning that can influence decisional dynamics in similar situations in future. These dynamics appeared to differ between participants, and between those who were more and less successful in weight management.

Conclusions

Our analysis and model of decision-making during weight-management have implications for the development and delivery of behavioural weight management interventions. By helping individuals to identify the drivers of their decision-making in key situations, and equipping them to manage these drivers, programmes may enhance their capacity to sustain the behaviour changes needed for long-term weight loss.

A Mobile Phone App Designed to Support Weight Loss Maintenance and Well-Being (MotiMate): Randomized Controlled Trial

Background

Few people successfully maintain lost weight over the longer term. Mobile phones have the potential to deliver weight loss management programs that can encourage self-monitoring while also providing some behavioral therapy to assist users in developing personal skills that may be necessary for improved longer term weight loss maintenance.

Objective

The aim of this study was to evaluate a program supporting weight maintenance, which uses a behaviorally based mobile phone app to manage weight, food, exercise, mood, and stress.

Methods

In a randomized controlled trial over 24 weeks, the full version of the app (MotiMate) was compared with a control app (monitoring only; excluding mood and stress) for its effect on weight, diet, and psychological well-being. Both apps had the same visual appearance and were designed to deliver all intervention content without face-to-face contact. The control version included features to track weight, food intake, and exercise with limited feedback and no encouraging/persuasive features. The intervention app included more persuasive and interactive features to help users track their weight, food intake, and physical activity and prompted users to enter data each day through notifications and included a mood and stress workshopping tool. Participants were recruited through advertising and existing databases. Clinic visits occurred at baseline, 4 weeks, 8 weeks, 12 weeks, and 24 weeks. At all visits, the clinical trial manager recorded body weight, and participants then completed a computer-delivered survey, which measured psychological and lifestyle outcomes. Objective app usage data were recorded throughout the trial.

Results

A total of 88 adults who had lost and maintained at least 5% of their body weight within the last 2 years were randomized (45 MotiMate and 43 control). Overall, 75% (66/88) were female, and 69% (61/88) completed week 24 with no differences in dropout by condition (χ²_1,87=0.7, P=.49). Mixed models suggested no significant changes in weight or psychological outcomes over 24 weeks regardless of condition. Of 61 completers, 53% (32/61) remained within 2% of their starting weight. Significant increases occurred over 24 weeks for satisfaction with life and weight loss self-efficacy regardless of app condition. Diet and physical activity behaviors did not vary by app or week. Negative binomial models indicated that those receiving the full app remained active users of the app for 46 days longer than controls (P=.02). Users of the full version of the app also reported that they felt more supported than those with the control app (P=.01).

Conclusions

Although some aspects of the intervention app such as usage and user feedback showed promise, there were few observable effects on behavioral and psychological outcomes. Future evaluation of the app should implement alternative research methods or target more specific populations to better understand the utility of the coping interface.

Trial Registration

Australia New Zealand Clinical Trials Registry ACTRN12614000474651; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366120

Difficulties in emotion regulation and deficits in interoceptive awareness in moderate and severe obesity

PURPOSE

Difficulties in emotion regulation and deficits in interoceptive awareness may be responsible for overeating and weight gain in obesity by increasing the risks of problematic eating behaviors. This study aimed to: (1) examine emotion regulation difficulties and interoceptive deficits in obesity; (2) compare the emotion regulation and interoceptive abilities of moderately and severely obese patients.

METHODS

Participants were recruited through the university, diabetology centers and bariatric surgery departments. A total of 165 participants were categorized in three groups, matched by age and gender, according to their Body Mass Index (BMI). The severely obese (SO), moderately obese (MO) and normal weight (NW) groups were constituted of 55 participants each. Self-report questionnaires were used to assess emotion regulation difficulties (CERQ-DERS) and interoceptive awareness (MAIA-FFMQ).

RESULTS

Overall, obese participants reported more emotion regulation difficulties and less interoceptive awareness than NW participants did. They also reported a lack of planning strategies and emotional awareness, as well as less ability to observe, notice and trust body sensations. No differences in emotion regulation and interoceptive abilities were found between MO and SO participants.

CONCLUSIONS

Emotion regulation and interoceptive awareness should be targeted in the psychotherapeutic care of obese people, regardless of their BMI.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Beyond weight loss: A qualitative exploration of participant expectations and strategies for measuring progress during a weight management program

Objectives:

Previous research with participants in weight management has primarily focused on participant weight-loss expectations. The purpose of this study was to explore participant expectations and strategies for measuring progress during a community-based weight management program.

Methods:

Semi-structured interviews were completed with 22 participants with overweight or obesity, who were currently enrolled in a 2-year weight management program in order to understand their expectations and strategies for measuring their progress.

Results:

Aside from weight loss, participants’ expectations included improved health, fitness, and mood, gaining support, and developing new habits. Participants discussed measuring their success by focusing on weight loss and changes to their body, improved health, mood, and fitness, creation of new habits, and gaining additional support.

Conclusion:

The results of this study suggest that participant’s in a weight management program expected benefits beyond just weight loss.

A qualitative analysis of the role of emotions in different patterns of long-term weight loss

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.