Mechanisms of Action in a Behavioral Weight-Management Program: Latent Growth Curve Analysis

Abstract Background A greater understanding of the mechanisms of action of weight-management interventions is needed to inform the design of effective interventions. Purpose To investigate whether dietary restraint, habit strength, or diet self-regulation mediated the impact of a behavioral weight-management intervention on weight loss and weight loss maintenance. Methods Latent growth curve analysis (LGCA) was conducted on trial data in which adults (N = 1,267) with a body mass index (BMI) ≥28 kg/m2 were randomized to either a brief intervention (booklet on losing weight), a 12 week weight-management program or the same program for 52 weeks. LGCA estimated the trajectory of the variables over four time points (baseline and 3, 12 and 24 months) to assess whether potential mechanisms of action mediated the impact of the weight-management program on BMI. Results Participants randomized to the 12 and 52 week programs had a significantly greater decrease in BMI than the brief intervention. This direct effect became nonsignificant when dietary restraint, habit strength, and autonomous diet self-regulation were controlled for. The total indirect effect was significant for both the 12 (estimate = −1.33, standard error [SE] = 0.41, p = .001) and 52 week (estimate = −2.13, SE = 0.52, p < .001) program. Only the individual indirect effect for dietary restraint was significant for the 12 week intervention, whereas all three indirect effects were significant for the 52 week intervention. Conclusions Behavior change techniques that target dietary restraint, habit strength, and autonomous diet self-regulation should be considered when designing weight loss and weight loss maintenance interventions. Longer interventions may need to target both deliberative and automatic control processes to support successful weight management.

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A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study (Preprint)

10.2196/preprints.18098 ◽

2020 ◽

Author(s):

Justin B Moore ◽

Joshua R Dilley ◽

Camelia R Singletary ◽

Joseph A Skelton ◽

David P Miller Jr ◽

...

Keyword(s):

Physical Activity ◽

Clinical Trial ◽

Weight Loss ◽

Weight Management ◽

Management Program ◽

Evidence Based ◽

Weight Management Program ◽

Management Protocol ◽

Pediatric Weight Management ◽

The Impact

BACKGROUND Severe obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment. OBJECTIVE This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program. METHODS Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points. RESULTS This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021. CONCLUSIONS The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/18098

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A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study

JMIR Research Protocols ◽

10.2196/18098 ◽

2020 ◽

Vol 9 (6) ◽

pp. e18098

Author(s):

Justin B Moore ◽

Joshua R Dilley ◽

Camelia R Singletary ◽

Joseph A Skelton ◽

David P Miller Jr ◽

...

Keyword(s):

Physical Activity ◽

Clinical Trial ◽

Weight Loss ◽

Weight Management ◽

Management Program ◽

Evidence Based ◽

Weight Management Program ◽

Management Protocol ◽

Pediatric Weight Management ◽

The Impact

Background Severe obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment. Objective This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program. Methods Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points. Results This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021. Conclusions The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial. International Registered Report Identifier (IRRID) PRR1-10.2196/18098

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The Effect of Cost Sharing on an Employee Weight Loss Program: A Randomized Trial

American Journal of Health Promotion ◽

10.1177/0890117116671282 ◽

2016 ◽

Vol 32 (1) ◽

pp. 170-176 ◽

Cited By ~ 6

Author(s):

Leslie K. John ◽

Andrea B. Troxel ◽

William S. Yancy ◽

Joelle Friedman ◽

Jingsan Zhu ◽

...

Keyword(s):

Weight Loss ◽

Randomized Trial ◽

Weight Management ◽

Program Effectiveness ◽

Pragmatic Trial ◽

Management Program ◽

Future Research ◽

Weight Management Program ◽

Alternative Designs ◽

The Impact

Purpose: To test the effects of employer subsidies on employee enrollment, attendance, and weight loss in a nationally available weight management program. Design: A randomized trial tested the impact of employer subsidy: 100%; 80%, 50%, and a hybrid 50% subsidy that could become a 100% subsidy by attaining attendance targets. Trial registration: NCT01756066. Setting and Participants: Twenty three thousand twenty-three employees of 2 US companies. Measures: The primary outcome was the percentage of employees who enrolled in the weight management program. We also tested whether the subsidies were associated with differential attendance and weight loss over 12 months, as might be predicted by the expectation that they attract employees with differing degrees of motivation. Analysis and Results: Enrollment differed significantly by subsidy level ( P < .0001). The 100% subsidy produced the highest enrollment (7.7%), significantly higher than each of the lower subsidies (vs 80% subsidy: 6.2%, P = .002; vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Enrollment in the 80% subsidy group was significantly higher than both lower subsidy groups (vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Among enrollees, there were no differences among the 4 groups in attendance or weight loss. Conclusion: This pragmatic trial, conducted in a real-world workplace setting, suggests that higher rates of employer subsidization help individuals to enroll in weight loss programs, without a decrement in program effectiveness. Future research could explore the cost-effectiveness of such subsidies or alternative designs.

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“Move it & lose it” — The impact of a self-monitored weight management program on weight loss and healthy weight loss practices

Journal of the American Dietetic Association ◽

10.1016/0002-8223(93)91018-l ◽

1993 ◽

Vol 93 (9) ◽

pp. A9

Author(s):

P.E Bucaccio ◽

M.A Gettings ◽

T.C Tomci

Keyword(s):

Weight Loss ◽

Weight Management ◽

Management Program ◽

Weight Management Program ◽

Healthy Weight ◽

The Impact

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Association of a Self-Paid Medically Supervised Weight Management Program with Reversal of Obesity-Associated Impaired Fasting Glucose

Clinics and Practice ◽

10.3390/clinpract11020053 ◽

2021 ◽

Vol 11 (2) ◽

pp. 386-394

Author(s):

Vijaya Surampudi ◽

Xinkai Zhou ◽

Chi-Hong Tseng ◽

David Heber ◽

Zhaoping Li

Keyword(s):

Weight Loss ◽

Blood Glucose ◽

Retrospective Analysis ◽

Weight Management ◽

Impaired Fasting Glucose ◽

Fasting Glucose ◽

Fasting Blood Glucose ◽

Management Program ◽

Weight Management Program ◽

Glucose Levels

Aims: The progression of prediabetes to T2DM can be delayed through diet modification and weight management. However, the intensive lifestyle program is often not covered by medical insurance. This retrospective analysis evaluates the association of a patient self-paid weight management program on an improvement of blood sugar in overweight and obese patients with impaired fasting glucose (IFG). Methods: The medical records of 4634 patients who participated in the self-pay UCLA Weight Management Program were reviewed and 2572 patients met the criteria for this retrospective analysis to examine whether this program was associated with the reversal of IFG over 3 months among 1396 patients with normal fasting glucose (NFG) and 1176 with IFG. Results: The patients with IFG lost comparable amounts of weight (10.5 ± 1.3 kg) at three months, as did the subjects with NFG (10.1 ± 1.3 kg). Fasting blood glucose in the IFG group decreased from 108.49 ± 6.4 to 101.8 ± 9.41 mg/dL (p < 0.0001) after three months. There were also significant reductions in triglycerides, and both systolic and diastolic blood pressure in both groups in association with weight loss. Conclusion: Our medically supervised self-pay multidisciplinary weight management program was associated with reduced fasting blood glucose levels in patients with IFG over three months with comparable weight loss to patients with NFG.

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Impact of the COVID‐19 pandemic on initial weight loss in a digital weight management program: A natural experiment

Obesity ◽

10.1002/oby.23233 ◽

2021 ◽

Author(s):

Tiffany Bullard ◽

Adam Medcalf ◽

Chad Rethorst ◽

Gary D. Foster

Keyword(s):

Weight Loss ◽

Weight Management ◽

Natural Experiment ◽

Management Program ◽

Weight Management Program ◽

Initial Weight ◽

Initial Weight Loss

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Predictors of Weight Loss Maintenance following an Insurance-Sponsored Weight Management Program

Journal of Obesity ◽

10.1155/2014/736080 ◽

2014 ◽

Vol 2014 ◽

pp. 1-12 ◽

Cited By ~ 11

Author(s):

Christiaan G. Abildso ◽

Olivier Schmid ◽

Megan Byrd ◽

Sam Zizzi ◽

Alessandro Quartiroli ◽

...

Keyword(s):

Weight Loss ◽

Weight Management ◽

Weight Loss Maintenance ◽

The United States ◽

Management Program ◽

Weight Management Program ◽

Post Intervention ◽

Physically Active ◽

Intentional Weight Loss ◽

Predictors Of Weight Loss

Intentional weight loss among overweight and obese adults (body mass index ≥ 25 kg/m2) is associated with numerous health benefits, but weight loss maintenance (WLM) following participation in weight management programming has proven to be elusive. Many individuals attempting to lose weight join formal programs, especially women, but these programs vary widely in focus, as do postprogram weight regain results. We surveyed 2,106 former participants in a community-based, insurance-sponsored weight management program in the United States to identify the pre, during, and post-intervention behavioral and psychosocial factors that lead to successful WLM. Of 835 survey respondents (39.6% response rate), 450 met criteria for inclusion in this study. Logistic regression analyses suggest that interventionists should assess and discuss weight loss and behavior change perceptions early in a program. However, in developing maintenance plans later in a program, attention should shift to behaviors, such as weekly weighing, limiting snacking in the evening, limiting portion sizes, and being physically active every day.

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