Ecological Momentary Assessment of Dietary Lapses Across Behavioral Weight Loss Treatment: Characteristics, Predictors, and Relationships with Weight Change

Abstract Background Individuals receiving behavioral weight loss treatment frequently fail to adhere to prescribed dietary and self-monitoring instructions, resulting in weight loss clinicians often needing to assess and intervene in these important weight control behaviors. A significant obstacle to improving adherence is that clinicians and clients sometimes disagree on the degree to which clients are actually adherent. However, prior research has not examined how clinicians and clients differ in their perceptions of client adherence to weight control behaviors, nor the implications for treatment outcomes. Purpose In the context of a 6-month weight-loss treatment, we examined differences between participants and clinicians when rating adherence to weight control behaviors (dietary self-monitoring; limiting calorie intake) and evaluated the hypothesis that rating one’s own adherence more highly than one’s clinician would predict less weight loss during treatment. Methods Using clinician and participant-reported measures of self-monitoring and calorie intake adherence, each assessed using a single item with a 7- or 8-point scale, we characterized discrepancies between participant and clinician adherence and examined associations with percent weight change over 6 months using linear mixed-effects models. Results Results indicated that ratings of adherence were higher when reported by participants and supported the hypothesis that participants who provided higher adherence ratings relative to their clinicians lost less weight during treatment (p < 0.001). Conclusions These findings suggest that participants in weight loss treatment frequently appraise their own adherence more highly than their clinicians and that participants who do so to a greater degree tend to lose less weight.

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

Obesity ◽

10.1002/oby.21925 ◽

2017 ◽

Vol 25 (9) ◽

pp. 1509-1515 ◽

Cited By ~ 12

Author(s):

Emily H. Feig ◽

Michael R. Lowe

Keyword(s):

Weight Loss ◽

Weight Change ◽

Clinical Implications ◽

Behavioral Weight Loss ◽

Weight Loss Treatment ◽

Behavioral Weight Loss Treatment

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Are individuals with loss-of-control eating more prone to dietary lapse in behavioural weight loss treatment? An ecological momentary assessment study

European Eating Disorders Review ◽

10.1002/erv.2583 ◽

2018 ◽

Vol 26 (3) ◽

pp. 259-264 ◽

Cited By ~ 4

Author(s):

Stephanie M. Manasse ◽

Leah M. Schumacher ◽

Stephanie P. Goldstein ◽

Gerald J. Martin ◽

Ross D. Crosby ◽

...

Keyword(s):

Weight Loss ◽

Ecological Momentary Assessment ◽

Loss Of Control ◽

Loss Of Control Eating ◽

Weight Loss Treatment ◽

Assessment Study ◽

Ecological Momentary ◽

Momentary Assessment

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Combining ecological momentary assessment, wrist-based eating detection, and dietary assessment to characterize dietary lapse: A multi-method study protocol

Digital Health ◽

10.1177/2055207620988212 ◽

2021 ◽

Vol 7 ◽

pp. 205520762098821

Author(s):

Stephanie P Goldstein ◽

Adam Hoover ◽

E Whitney Evans ◽

J Graham Thomas

Keyword(s):

Weight Loss ◽

Eating Behavior ◽

Ecological Momentary Assessment ◽

Structured Interview ◽

Self Report ◽

Significant Weight Loss ◽

Clinically Significant ◽

Ecological Momentary ◽

Momentary Assessment ◽

Lapse Behavior

Objectives Behavioral obesity treatment (BOT) produces clinically significant weight loss and health benefits for many individuals with overweight/obesity. Yet, many individuals in BOT do not achieve clinically significant weight loss and/or experience weight regain. Lapses (i.e., eating that deviates from the BOT prescribed diet) could explain poor outcomes, but the behavior is understudied because it can be difficult to assess. We propose to study lapses using a multi-method approach, which allows us to identify objectively-measured characteristics of lapse behavior (e.g., eating rate, duration), examine the association between lapse and weight change, and estimate nutrition composition of lapse. Method We are recruiting participants (n = 40) with overweight/obesity to enroll in a 24-week BOT. Participants complete biweekly 7-day ecological momentary assessment (EMA) to self-report on eating behavior, including dietary lapses. Participants continuously wear the wrist-worn ActiGraph Link to characterize eating behavior. Participants complete 24-hour dietary recalls via structured interview at 6-week intervals to measure the composition of all food and beverages consumed. Results While data collection for this trial is still ongoing, we present data from three pilot participants who completed EMA and wore the ActiGraph to illustrate the feasibility, benefits, and challenges of this work. Conclusion This protocol will be the first multi-method study of dietary lapses in BOT. Upon completion, this will be one of the largest published studies of passive eating detection and EMA-reported lapse. The integration of EMA and passive sensing to characterize eating provides contextually rich data that will ultimately inform a nuanced understanding of lapse behavior and enable novel interventions. Trial registration: Registered clinical trial NCT03739151; URL: https://clinicaltrials.gov/ct2/show/NCT03739151

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