A Conceptual Model of Long-Term Weight Loss Maintenance: The Importance of Cognitive, Empirical and Computational Approaches

Living with obesity is related to numerous negative health outcomes, including various cancers, type II diabetes, and cardiovascular disease. Although much is known about the factors associated with obesity, and a range of weight loss interventions have been established, changing health-related behaviours to positively affect obesity outcomes has proven difficult. In this paper, we first draw together major factors that have emerged within the literature on weight loss to describe a new conceptual framework of long-term weight loss maintenance. Key to this framework is the suggestion that increased positive social support influences a reduction in psychosocial stress, and that this has the effect of promoting better executive functioning which in turn facilitates the development of healthy habits and the breaking of unhealthy habits, leading to improved ongoing maintenance of weight loss. We then outline how the use of computational approaches are an essential next step, to more rigorously test conceptual frameworks, such as the one we propose, and the benefits that a mixture of conceptual, empirical and computational approaches offer to the field of health psychology.

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Persuasive System Design Principles and Behavior Change Techniques to Stimulate Motivation and Adherence in Electronic Health Interventions to Support Weight Loss Maintenance: Scoping Review (Preprint)

10.2196/preprints.14265 ◽

2019 ◽

Author(s):

Rikke Aune Asbjørnsen ◽

Mirjam Lien Smedsrød ◽

Lise Solberg Nes ◽

Jobke Wentzel ◽

Cecilie Varsi ◽

...

Keyword(s):

Weight Loss ◽

Behavior Change ◽

Goal Setting ◽

Weight Loss Maintenance ◽

Behavior Change Techniques ◽

Self Monitoring ◽

Support Weight ◽

And Behavior ◽

Weight Loss Interventions

BACKGROUND Maintaining weight after weight loss is a major health challenge, and eHealth (electronic health) solutions may be a way to meet this challenge. Application of behavior change techniques (BCTs) and persuasive system design (PSD) principles in eHealth development may contribute to the design of technologies that positively influence behavior and motivation to support the sustainable health behavior change needed. OBJECTIVE This review aimed to identify BCTs and PSD principles applied in eHealth interventions to support weight loss and weight loss maintenance, as well as techniques and principles applied to stimulate motivation and adherence for long-term weight loss maintenance. METHODS A systematic literature search was conducted in PsycINFO, Ovid MEDLINE (including PubMed), EMBASE, Scopus, Web of Science, and AMED, from January 1, 2007 to June 30, 2018. Arksey and O’Malley’s scoping review methodology was applied. Publications on eHealth interventions were included if focusing on weight loss or weight loss maintenance, in combination with motivation or adherence and behavior change. RESULTS The search identified 317 publications, of which 45 met the inclusion criteria. Of the 45 publications, 11 (24%) focused on weight loss maintenance, and 34 (76%) focused on weight loss. Mobile phones were the most frequently used technology (28/45, 62%). Frequently used wearables were activity trackers (14/45, 31%), as well as other monitoring technologies such as wireless or digital scales (8/45, 18%). All included publications were anchored in behavior change theories. Feedback and monitoring and goals and planning were core behavior change technique clusters applied in the majority of included publications. Social support and associations through prompts and cues to support and maintain new habits were more frequently used in weight loss maintenance than weight loss interventions. In both types of interventions, frequently applied persuasive principles were self-monitoring, goal setting, and feedback. Tailoring, reminders, personalization, and rewards were additional principles frequently applied in weight loss maintenance interventions. Results did not reveal an ideal combination of techniques or principles to stimulate motivation, adherence, and weight loss maintenance. However, the most frequently mentioned individual techniques and principles applied to stimulate motivation were, personalization, simulation, praise, and feedback, whereas associations were frequently mentioned to stimulate adherence. eHealth interventions that found significant effects for weight loss maintenance all applied self-monitoring, feedback, goal setting, and shaping knowledge, combined with a human social support component to support healthy behaviors. CONCLUSIONS To our knowledge, this is the first review examining key BCTs and PSD principles applied in weight loss maintenance interventions compared with those of weight loss interventions. This review identified several techniques and principles applied to stimulate motivation and adherence. Future research should aim to examine which eHealth design combinations can be the most effective in support of long-term behavior change and weight loss maintenance.

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Through Thick and Thin: Identifying Barriers to Bariatric Surgery, Weight Loss Maintenance, and Tailoring Obesity Treatment for the Future

Surgery Research and Practice ◽

10.1155/2016/8616581 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Donevan Westerveld ◽

Dennis Yang

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Weight Control ◽

Weight Loss Maintenance ◽

The United States ◽

Physician Perceptions ◽

Perceptions And Attitudes ◽

Treatment Of Obesity ◽

Weight Loss Interventions

More than one-third of the adults in the United States are obese. This complex metabolic disorder is associated with multiple comorbidities and increased all-cause mortality. Bariatric surgery has been shown to be more effective than medical therapy and has been associated with weight loss maintenance and decreased mortality. In spite of these well-established benefits, less than 1% of candidates undergo surgery due to multiple factors, such as patient and physician perceptions and attitudes, patient-physician interaction, lack of resources, and cost burden. Furthermore, even in patients who do undergo bariatric surgery and/or alternate weight loss interventions, long-term weight control is associated with high-risk failure and weight regain. In this review, we highlight some of the current barriers to bariatric surgery and long-term weight loss maintenance and underscore the importance of an individualized multidisciplinary longitudinal strategy for the treatment of obesity.

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Self-guided Change: The most common form of long-term, maintained health behavior change

Health Psychology Open ◽

10.1177/2055102917751576 ◽

2018 ◽

Vol 5 (1) ◽

pp. 205510291775157 ◽

Cited By ~ 3

Author(s):

F Michler Bishop

Keyword(s):

Weight Loss ◽

Health Behavior ◽

Behavior Change ◽

Scoping Review ◽

Health Behavior Change ◽

Significant Cost ◽

Health Related Behaviors ◽

Health Related ◽

The One

Millions of people change risky, health-related behaviors and maintain those changes. However, they often take years to change, and their unhealthy behaviors may harm themselves and others and constitute a significant cost to society. A review—similar in nature to a scoping review—was done of the literature related to long-term health behavior change in six areas: alcohol, cocaine and heroin misuse, gambling, smoking, and overeating. Based on the limited research available, reasons for change and strategies for changing and for maintaining change were also reviewed. Fifty years of research clearly indicate that as people age, in the case of alcohol, heroin and cocaine misuse, smoking, and gambling, 80–90 percent moderate or stop their unhealthy behaviors. The one exception is overeating; only 20 percent maintain their weight loss. Most of these changes, when they occur, appear to be the result of self-guided change. More ways to accelerate self-guided, health-related behavior change need to be developed and disseminated.

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Behavioral Mediators of Long-Term Weight Loss Maintenance

PsycEXTRA Dataset ◽

10.1037/e500822014-008 ◽

2013 ◽

Author(s):

J. W. Coughlin ◽

C. M. Gullion ◽

P. J. Brantley ◽

V. J. Stevens ◽

A. Bauck ◽

...

Keyword(s):

Weight Loss ◽

Weight Loss Maintenance

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Perspectives into the experience of successful, substantial long-term weight-loss maintenance: a systematic review

International Journal of Qualitative Studies on Health and Well-Being ◽

10.1080/17482631.2020.1862481 ◽

2021 ◽

Vol 16 (1) ◽

pp. 1862481

Author(s):

Marie Spreckley ◽

Jaap Seidell ◽

Jutka Halberstadt

Keyword(s):

Systematic Review ◽

Weight Loss ◽

Weight Loss Maintenance

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Long-term weight loss maintenance in the United States

International Journal of Obesity ◽

10.1038/ijo.2010.94 ◽

2010 ◽

Vol 34 (11) ◽

pp. 1644-1654 ◽

Cited By ~ 216

Author(s):

J L Kraschnewski ◽

J Boan ◽

J Esposito ◽

N E Sherwood ◽

E B Lehman ◽

...

Keyword(s):

United States ◽

Weight Loss ◽

Weight Loss Maintenance ◽

The United States

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Development of a web-based, guided self-help, ACT-based intervention for weight loss maintenance: an evidence-, theory- and person-based approach. (Preprint)

10.2196/preprints.31801 ◽

2021 ◽

Author(s):

Rebecca Richards ◽

Rebecca A Jones ◽

Fiona Whittle ◽

Carly A Hughes ◽

Andrew J Hill ◽

...

Keyword(s):

Weight Loss ◽

Weight Management ◽

Evidence Theory ◽

Intervention Development ◽

Weight Loss Maintenance ◽

Theoretical Modelling ◽

Healthcare Intervention ◽

Web Based ◽

Self Help

BACKGROUND The long-term impact and cost-effectiveness of weight management programmes depends on post-treatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioural therapy (3wCBT), specifically acceptance and commitment therapy (ACT), could improve long-term weight management however these interventions are typically delivered face-to-face by psychologists, which limits the scalability of this type of intervention. OBJECTIVE To use an evidence-, theory- and person-based approach to develop an ACT-based intervention for weight-loss maintenance that uses digital technology and non-specialist guidance to minimise resources needed for delivery at scale. METHODS Intervention development was guided by the Medical Research Council framework for the development of complex interventions in healthcare, Intervention Mapping Protocol, and the person-based approach for enhancing the acceptability and feasibility of interventions. Two phases of work were conducted: phase one consisted of collating and analysing existing and new primary evidence, and phase two consisted of theoretical modelling and intervention development. Phase one included a synthesis of existing evidence on weight-loss maintenance from previous research, a systematic review and network meta-analysis of 3wCBT interventions for weight management, a qualitative interview study of experiences of weight-loss maintenance, and the modelling of a justifiable cost for a weight-loss maintenance programme. Phase two included iterative development of guiding principles, a logic model and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development and user-testing of successive iterations of the prototype intervention were conducted. RESULTS This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month programme, consisting of weekly web-based sessions for 13 consecutive weeks, followed by a 4-week break for participants to reflect and practice their new skills, and a final session at week 17. Each session consists of psychoeducational content, reflective exercises, and behavioural experiments. SWiM includes specific sessions on key determinants of weight-loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight-management. A trained, non-specialist coach provides guidance for participants through the programme with four scheduled 30-minute telephone calls and three further optional calls. CONCLUSIONS This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence of how to support people with weight-loss maintenance, and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on findings of a planned pilot randomised controlled trial.

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