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A qualitative analysis of the role of emotions in different patterns of long-term weight loss
Psychology & Health
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.
... Overall, 294 female and male, adult, individuals of varying ethnicity participated in the identified studies, with sample sizes ranging from 9 to 44 participants. 32 of the 15 identified studies also included individuals who always maintained their weight within the healthy BMI range to date (Carrard & Kruseman, 2016;Kruseman et al., 2017;Reilly et al., 2015) and 5 had weight regainers Ingels & Zizzi, 2018;McKee et al., 2013;Pedersen et al., 2018;Reilly et al., 2015). This provides valuable, additional insights into what separates weight maintainers and regainers in terms of experiences, challenges and strategies utilized to achieve long-term weight loss maintenance. ...
... Seven studies used the above definition of having achieved ≥10% of body weight loss sustained over 1 year Carrard & Kruseman, 2016;Epiphaniou & Ogden, 2010;Karfopoulou et al., 2013;Kruseman et al., 2017;McKee et al., 2013;Pedersen et al., 2018), while others defined it as having achieved ≥10% of body weight loss sustained over 5 years . Some defined it as having achieved ≥10 kg of body weight loss sustained over 7 years (Sarlio-Lähteenkorva, 2000) and others defined it as having achieved ≥5% of body weight loss sustained over 1 year , having achieved ≥13.6 kg of body weight loss sustained over 1 year , having achieved ≥6.35 kg of body weight loss sustained over 1 year and having achieved ≥7% of body weight loss sustained over 1 year (Ingels & Zizzi, 2018). One study included participants whose weight change ranged from having achieved a 10.4% body weight loss to having regained up to 4.0% of body weight over a year (Cleo et al., 2018). ...
... Intrinsic challenges ranged from everyday stress Kwasnicka et al., 2019;Pedersen et al., 2018) to a lack of time to engage in WLM associated behaviours like exercise Metzgar et al., 2015). Emotional eating was another challenge that featured strongly in the studies, which was frequently utilized to regulate emotions as well as manage stress and boredom (Epiphaniou & Ogden, 2010;Ingels & Zizzi, 2018;Karfopoulou et al., 2013;Reilly et al., 2015). Life events such as pregnancy, illness or injury also challenged WLM success, potentially interrupting important routines and habits to maintain weight loss success . ...
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.
... The goal was to gain insights into the experience of weight management and the resulting consequences encountered. Research into the experience of substantial, sustainable weight-loss maintenance has continuously found that individuals with overweight and obesity experienced the achievement of substantial, sustainable weight-loss maintenance to be challenging due to varying factors including everyday stress [29][30][31][32][33][34][35], emotional eating and boredom [33,34,36,37], planned life events [14,29,30,38,39] as well as unplanned life events [29,33,34], amongst others. Environmental influences have also frequently been cited as potentially derailing factors including discouraging peers [30][31][32][39][40][41], the obesogenic food environment [14,30] and the inability to stay motivated without support [36,42]. ...
... Research into the experience of substantial, sustainable weight-loss maintenance has continuously found that individuals with overweight and obesity experienced the achievement of substantial, sustainable weight-loss maintenance to be challenging due to varying factors including everyday stress [29][30][31][32][33][34][35], emotional eating and boredom [33,34,36,37], planned life events [14,29,30,38,39] as well as unplanned life events [29,33,34], amongst others. Environmental influences have also frequently been cited as potentially derailing factors including discouraging peers [30][31][32][39][40][41], the obesogenic food environment [14,30] and the inability to stay motivated without support [36,42]. A lack of HCP understanding and support has also consistently been experienced as a barrier [18,43]. ...
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.
... Public health campaigns, healthcare providers, and media messages should focus on promoting holistic approaches to health and weight that emphasize factors beyond individual behavior, such as structural and environmental influences, to avoid inadvertently promoting maladaptive weight-related behaviors. Such interventions may also help alleviate feelings of shame and self-criticism, common emotions after unsuccessful weight loss attempts or weight regain [58] that can lead to further negative eating patterns [59]. ...
Individuals with obesity who use glucagon-like peptide 1 receptor agonists (GLP-1s) for weight loss are often judged for taking a “shortcut” rather than using “optimal” methods (i.e., diet/exercise). This is linked with beliefs that weight is highly controllable, which predict both anti-fat attitudes and maladaptive weight-related behaviors. This study tested how exposure to a woman whose weight was framed as highly controllable or largely uncontrollable and who was described as losing weight with a GLP-1 vs. diet/exercise affected weight stigma attitudes and maladaptive weight-related cognitions through social comparison processes.
Women with overweight and obesity (N = 163) were exposed to a woman with obesity who varied by described weight controllability and weight loss method. Participants reported the extent to which they engaged in global downward social comparison and weight and body size comparisons to the woman, as well as weight stigma attitudes and maladaptive weight-related cognitions (likelihood of engaging in binge eating, restrictive eating, and exercising hard to control weight).
When the woman lost weight with a GLP-1 (vs. diet/exercise) she was judged more negatively due, in part, to higher global downward social comparison. Reading about weight loss with diet/exercise (vs. GLP-1) led to more maladaptive weight-related cognitions through higher weight and body size comparisons. Emphasizing that weight is less controllable did not reduce stigmatizing attitudes towards a GLP-1 user and had a limited effect on weight-related cognitions.
Further research is necessary to identify interventions to reduce weight stigma towards GLP-1 users and maladaptive weight-related cognitions.
... Most of the discovered themes of this study were aligned with the findings of existing qualitative literature on sustainable weight-loss maintenance. Qualitative research investigating the experience of long-term weight loss maintenance for individuals with overweight or obesity has frequently found that utilizing clear self-monitoring strategies and making those strategies habitual, personalized, agile and structured led to superior long-term outcomes (Carrard & Kruseman, 2016;Elfhag & Rossner, 2005;Epiphaniou & Ogden, 2010;Garip & Yardley, 2011;Ingels & Zizzi, 2018;Karfopoulou et al., 2013;Kwasnicka et al., 2019;McKee et al., 2013;Metzgar et al., 2015;Natvik et al., 2018Natvik et al., , 2019Pedersen et al., 2018;Reilly et al., 2015;Sarlio-Lähteenkorva, 2000;Simpson et al., 2011;Spreckley et al., 2021). The wideranging benefits experienced due to sustained weight loss including improved health, self-perception, optimism and confidence have also frequently been determined and often served as fuel for continued motivation (Carrard & Kruseman, 2016;Epiphaniou & Ogden, 2010;Kwasnicka et al., 2019;McKee et al., 2013;Natvik et al., 2018Natvik et al., , 2019Sarlio-Lähteenkorva, 2000;Spreckley et al., 2021). ...
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.
... For the participants in this study, emotional awareness and regulation seem to be extremely important in weight control. Ingels and Zizzi (2018) Life satisfaction is defined as the contentment level that a person perceives (Hutz et al., 2014), and subjective well-being can be understood by how people feel and evaluate themselves (Oliveira, Nunes, Legal, & Noronha, 2016). Therefore, an individual with high well-being has high levels of positive and negative affects, and high satisfaction with life (Zanon, Dellazzana-Zanon, L., & Hutz, 2014). ...
This study aimed to analyze which factors can favor or hinder healthy habits and the character forces associated with weight maintenance, in adults who underwent a weight loss program at a Contemporary Health and Wellness Center. This is a qualitative, cross-sectional, exploratory, and descriptive study. Seven people conducted semi-structured interviews, analyzed using the Thematic Analysis by Braun and Clarke. The results show that learning and discipline are extremely important for maintaining the habits learned in the program. Situations such as work, family, and aging can generate negative emotions and interfere with life satisfaction, making health habits more difficult. The forces of self-regulation, persistence, love of learning, humor, and appreciation of beauty can present favorable returns to weight maintenance. The development of character strengths can be extremely important for the maintenance of body weight after carrying out a weight loss program.
... The ability to regulate emotions was a commonly reported barrier [36,[40][41][42][43]46,48,49] and may have been a strong contributing factor to weight regain. Managing difficult or unwanted thoughts and feelings is crucial for long-term weight loss success [69,70], yet many weight loss interventions do not address this aspect of behaviour. As recommended by previous research [34], future weight management interventions should help individuals recognise and manage psychological obstacles such as maladaptive behaviours and emotional regulation. ...
Long-term weight loss maintenance is often difficult to achieve. This review analysed qualitative data on self-perceived barriers and facilitators of weight loss and weight loss maintenance among weight loss intervention participants. A literature search was conducted using electronic databases. Qualitative studies written in English and published between 2011–2021 were eligible for inclusion if they explored the perspectives and experiences of individuals who received standardised dietary and behavioural support for weight loss. Studies were excluded if weight loss was achieved through self-directed methods, only increasing physical activity, or surgical or pharmacological interventions. Fourteen studies were included, totaling 501 participants from six countries. Thematic analysis was used to identify four aggregate themes: internal factors (i.e., motivation and self-efficacy), programme-specific factors (i.e., the intervention diet), social factors (i.e., supporters and saboteurs), and environmental factors (i.e., an obesogenic environment). Our findings demonstrate that internal, social, and environmental factors all influence weight loss success, as well as the acceptability of the weight loss intervention. Future interventions may be more successful if they prioritise participant acceptability and engagement by, for example, providing tailored interventions, a structured relapse management plan, strategies to enhance autonomous motivation and emotional self-regulation, and extended contact during weight loss maintenance.
... Participant baseline characteristics are described in Table I. The sample size was estimated to be sufficient based on previous relevant studies and the pragmatic restraints of the COVID-19 pandemic (Ahern et al., 2013;Ingels & Zizzi, 2019;Johansson et al., 2015;Rand et al., 2017). Interview participants were given a minimum of 48 hours to read the participant information sheet and multiple opportunities to ask questions. ...
Purpose
We aimed to explore participants' experiences of mental health during an acceptance and commitment therapy (ACT)-based guided self-help intervention to support weight management in adults with overweight or obesity during the COVID-19 pandemic (SWiM-C: Supporting Weight Management during COVID-19).
Methods
We conducted semi-structured telephone interviews with twenty participants and used reflexive thematic analysis to identify patterns of meaning across the dataset relevant to mental health.
Results
Four themes were conceptualized: i) Mental health changes associated with SWiM-C, ii) External factors negatively impacted mental health and intervention engagement, iii) Use and impact of coping responses, and iv) Intervention preferences based on psychological needs.
Conclusions
Findings suggest that participants were exposed to multiple factors, both related to and external to the intervention, that negatively impact their mental health, yet ACT-based aspects of the SWiM-C intervention appeared to support participants to adaptively manage the decline in their mental health. The findings can be used to inform the development of future weight management interventions, such as through intervention personalization and the inclusion of more strategies that target emotional regulation.
Trial registration: ISRCTN 12107048, https://www.isrctn.com/ISRCTN12107048
... Emotions can influence eating behaviour and consequently weight loss, since emotional eaters, those who tend to eat in response to negative emotions such as anxiety and irritability, tend to eat more in response to stress (Wallis and Hetherington, 2009). Thus, mindfulnessbased interventions that improve emotional self-regulation by reducing compensatory behaviours (Frayn et al., 2018) may contribute to greater weight loss (Dunn et al., 2018;Ingels and Zizzi, 2018;Olson and Emery, 2015). ...
Background: Worldwide, approximately 95% of obese people who follow diets for weight loss fail to maintain their weight loss in the long term. To fill this gap, mindfulness-based interventions, with a focus on mindful eating, are promising therapies to address this challenging public health issue. Aim: To verify the effects of the Mindfulness-Based Eating Awareness Training (MB-EAT) protocol by exploring quantitative and qualitative data collected from Brazilian women. Methods: A single-group, mixed-methods trial was conducted at a public university with adult women (n = 34). Four MB-EAT groups were offered weekly for 2.5-h sessions over 12 weeks. Pre-and post-intervention assessments included body mass index (BMI) and self-report measures of anxiety, depression, mindfulness, self-compassion, and eating behaviour. Qualitative information was collected using focus groups in the last session of each group, including both participants and MB-EAT instructors. The qualitative data were examined using thematic analyses and empirical categories. Results: Twenty participants (58.8%) completed both pre-and post-intervention assessments, with adequate attendance (≥4 sessions). There was a significant average decrease in weight of 1.9 ± 0.6 kg from pre-to post-intervention. All participants who had scored at the risk level for eating disorders on the EAT-26 decreased their score below this risk level. Qualitative analysis identified that participants were able to engage a more compassionate perspective on themselves, as well as greater self-awareness and self-acceptance. Conclusion: The MB-EAT showed preliminary efficacy in promoting weight loss and improvements in mindfulness and eating behaviour. This intervention promoted effects beyond those expected, extending to other life contexts.
... For example, enhanced emotional abilities to cope with stressful situations may increase one's ability to sustain healthy dietary behaviors under stressful conditions (Smyth and Arigo 2009). Conversely, psychological distress has been associated with maladaptive health behaviors such as non-adherence to smoking cessation (Cosci et al. 2011) and reduced commitment to sustaining weight loss (Ingels and Zizzi 2018). In sum, improved emotion regulation has the potential to facilitate self-management of behavior and improve health outcomes. ...
Objectives
Mindfulness-based interventions (MBIs) have been widely implemented to improve self-regulation behaviors, often by targeting emotion-related constructs to facilitate change. Yet the degree to which MBIs engage specific measures of emotion-related constructs has not been systematically examined.
Methods
Using advanced meta-analytic techniques, this review examines construct and measurement engagement in trials of adults that used standardized applications of the two most established MBIs: Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), or modified variations of these interventions that met defined criteria.
Results
Seventy-two studies (N = 7,378) were included (MBSR k = 47, MBCT k = 21, modified k = 4). MBIs led to significant improvement in emotion-related processing overall, compared to inactive controls (d = 0.58; k = 36), and in all constructs assessed: depression (d = 0.66; k = 26), anxiety (d = 0.63; k = 19), combined mental health (d = 0.75; k = 7), and stress (d = 0.44; k = 11). Reactions to pain, mood states, emotion regulation, and biological measures lacked sufficient data for analysis. MBIs did not outperform active controls in any analyses. Measurement tool and population type did not moderate results, but MBI type did, in that MBCT showed stronger effects than MBSR, although these effects were driven by a small number of studies.
Conclusions
This review is the first to examine the full scope of emotion-related measures relevant to self-regulation, to determine which measures are most influenced by MBCT/MBSR. Compared to extant reviews, which typically focused on MBI outcomes, this work examined mechanistic processes based on measurement domains and tools. While effect sizes were similar among measurement tools, this review also includes a descriptive evaluation of measures and points of caution, providing guidance to MBI researchers and clinicians for selection of emotion-related measurement tools.
Os estilos de comportamentos alimentares Restrição Cognitiva (RC), Comer Incontrolável (CI) e Comer Emocional (CE), estão implicados no emagrecimento. Afetos positivos e negativos e forças de caráter podem apresentar recursos para um comportamento alimentar saudável. Analisou-se a associação entre os afetos e as forças de caráter em diferentes estilos de comportamento alimentar de 50 adultos após um programa de emagrecimento. Os que experimentaram menores níveis de afetos negativos apresentaram menos CE e CI e aquelas com menores níveis de afetos positivos relataram mais episódios de CI. Sobre as forças de caráter, pessoas com mais pensamento crítico, modéstia e autorregulação relataram maior controle sobre suas escolhas alimentares, pessoas com mais perseverança, inteligência social, esperança e espiritualidade apresentaram menor incidência de CE. Aqueles que possuem mais perdão, apreciação do belo e esperança demonstraram menor CI. O desenvolvimento de afetos positivos e de algumas forças de caráter podem favorecer comportamentos alimentares mais saudáveis.
The objectives of this study were to translate and validate the Persian version of the food involvement inventory (FII) and eating restriction questionnaire (ERQ) and to determine the measurement invariance based on gender, body mass index (BMI) status, and age. This cross-sectional study included 1100 Iranian adults. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the construct validity of FII and ERQ. Convergent and discriminant validity, measurement invariance in gender, BMI and age, reliability including internal consistency, and stability were investigated for FII and ERQ. The results showed that the four-factor construct of the FII and the one-factor construct of the ERQ were 44.27% and 55.12% of the total variance, respectively. The factor loadings of all items were > .3 in both scales and none of the items were deleted. Fitting indices indicated that the four-factor construct of the FII and the one-factor construct of the ERQ had a good and acceptable fit among the Iranian adults. The Persian versions of the FII and ERQ, translated into Persian and localized according to international standards, had high construct, convergent and discriminant validity as well as high reliability.
Within weight-loss treatments, a better understanding of psychosocial correlates of exercise and controlled eating is required to improve lagging outcomes. Within this two-phase study, women with obesity participating in community-based treatments with educational (Phase 1 n = 57, Phase 2 n = 44) and behavioral (Phase 1 n = 80, Phase 2 n = 53) formats were contrasted on psychosocial variables over 3 and 6 months and their interrelations based on the mood-behavior-model and coaction theory. Phase 1 findings informed curricular extensions in Phase 2. In Phase 1, there were significant overall improvements in total mood disturbance, self-regulation of exercise, self-regulation of eating, and weight, which were more pronounced in the behavioral vs. educational format group (-3.5 % vs. -1.4 % weight loss, respectively). Mediation analyses indicated that change in self-regulation of exercise mediated the prediction of change in self-regulation of eating by mood change. Phase 2 findings were similar; however, effect sizes were greater (-6.2 % vs. -2.9 % weight loss, respectively). Within both phases, increased self-regulation of eating significantly predicted weight reduction. Paths from changes in mood→self-regulation of exercise→self-regulation of eating suggested future program attention focus on treatment-associated mood change reinforcing self-regulation, and self-regulation generalizing from an exercise to eating context. Methods of progressing treatment curricula via theory-testing were suggested.
Recent research has suggested that obesity is a stigmatised condition. Concerns with personal inferiority (social rank), shame and self-criticism may impact on weight management behaviours. The current study examined associations between social comparison (shame, self-criticism), negative affect and eating behaviours in women attending a community based weight management programme focused on behaviour change. 2,236 participants of the programme completed an online survey using measures of shame, self-criticism, social comparison, and weight-related affect, which were adapted to specifically address eating behaviour, weight and body shape perceptions. Correlation analyses showed that shame, self-criticism and social comparison were associated with negative affect. All of these variables were related to eating regulation and weight control (p < 0.001). Path analysis revealed that the association of shame, hated-self, and low self-reassurance on disinhibition and susceptibility to hunger was fully mediated by weight-related negative affect, even when controlling for the effect of depressive symptoms (p < 0.050 to p < 0.010). In addition, feelings of inadequacy and unfavourable social comparisons were associated with higher disinhibition and susceptibility to hunger, partially mediated through weight-related negative affect (p = 0.001). These variables were negatively associated with extent of weight loss during programme attendance prior to the survey, while self-reassurance and positive social comparisons were positively associated with the extent of weight loss prior to the survey (p < .050). Shame, self-criticism, and perceptions of inferiority may play a significant role in self-regulation of eating behaviour in overweight people trying to manage their weight.
ABSTRACT
Critical realism (CR) is a useful philosophical framework for social science; however, little guidance is available on which precise methods – including methods of data collection, coding, and analysis – are best suited to applied
CR research. This article provides a concrete example of applied qualitative research using CR as a philosophical and methodological framework. Drawing examples from a study of Canadian farm women’s experiences
with agricultural policy, I suggest a flexible deductive process of coding and data analysis that is consistent with CR ontology and epistemology. The paper follows the typical stages of qualitative research while demonstrating
the application of methods informed by CR at each stage. Important considerations CR ontology and epistemology raise, such as the use of existing theory and critical engagement with participants’ knowledge and
experience, are discussed throughout. Ultimately, I identify two key causal mechanisms shaping the lives of farm women and suggest a future direction for feminist political economy theory to more effectively analyze women’s
work in agricultural contexts.
Background:
Preventing obesity is an international health priority. In Australia, young women who live in rural communities are at high risk of unhealthy weight gain. Interventions which engage young women and support sustainable behaviour change are needed and comprehensive evaluation of such interventions generates knowledge for population scale-up. This qualitative sub-study aims to identify enablers and barriers to behaviour change initiation and continuation within a community weight gain prevention program.
Methods:
In-depth semi-structured interviews were conducted with program participants 6 months after baseline. All interviews were audio-taped and transcribed verbatim. Transcripts were analysed independently by two investigators via thematic analysis.
Participants:
A total of 28 women with a mean age of 39.9±6.2years and a BMI of 28.6±5.2kg/m2 were purposively recruited from the larger cohort (n = 649) that participated in the prevention trial.
Results:
Four behaviour change groups emerged were identified from participant interviews: (i) no change, (ii) relapse, (iii) intermittent and (iv) continued change. Factors influencing behaviour change initiation and continuation included realistic program expectations and the participant's ability to apply the core program elements including: setting small, achievable behaviour change goals, problem solving and using self-management techniques. Personal knowledge, skills, motivation, self-efficacy, accountability and perceived social and environmental barriers also affected behaviour change. Satisfaction with personal program progress and the perceived amount of program supports required to achieve ongoing behaviour change varied amongst participants. Women who relapsed expressed a desire for more intensive and regular support from health professionals, identified more barriers unrelated to the program, anticipated significant weight loss and had lower satisfaction with their progress.
Conclusion:
Initiating and continuing behaviour change is a complex process. Our findings elucidate that initiation and continuation of behaviour change in women undertaking a weight gain prevention program may be facilitated by accurate and realistic understanding of program expectation, the ability to apply the core program messages, higher internal motivation, self-efficacy and minimal social and environmental barriers.
Trial registration:
Australia & New Zealand Clinical Trial Registry ACTRN12612000115831 www.anzctr.org.au.
Once weight loss is achieved, the challenge is to maintain this benefit. This review reports on the effectiveness of programs for weight-loss maintenance, as part of a larger review examining treatments for overweight and obese adults.
We updated the search of a 2011 review on screening and management of overweight and obese adults. Four databases were searched. For inclusion, participants had to have lost weight in treatment and then been randomly assigned to a weight-maintenance intervention or control conditions. Studies from the 2011 review that met the criteria were included. Data were extracted and pooled (where possible) for outcomes related to weight-loss maintenance.
Eight studies were included. Compared with control participants, intervention participants regained less weight (mean difference [MD] -1.44 kg, 95% confidence interval [CI] -2.42 to -0.47), regardless of whether the intervention was behavioural (MD-1.56 kg, 95% CI -3.10 to -0.02) or pharmacologic plus behavioural (MD -1.39 kg, 95% CI -2.86 to 0.08). Intervention participants also showed better weight maintenance than the control participants in terms of waist circumference (MD -2.30 cm, 95% CI -3.45 to -1.15) and body mass index (MD -0.95 kg/m(2), 95% CI -1.67 to -0.23). Participants undergoing pharmacologic plus behavioural interventions were more likely to maintain a loss of 5% or more of initial body weight than those in the control group (risk ratio [RR] 1.33, 95% CI 1.15 to 1.54); no difference was found for maintaining a weight loss of 10% or more (RR 1.76, 95% CI 0.75 to 4.12).
Moderate quality evidence shows that overweight and obese adults can benefit from interventions for weight maintenance following weight loss. However, there is insufficient evidence on the long-term sustainability of these benefits.
PROSPERO no. CRD42012002753.
Objective To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions.
Design Systematic review with meta-analysis.
Data sources Medline, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials.
Study selection Studies were identified through to January 2014. Randomised trials of interventions to maintain weight loss provided to initially obese adults (aged ≥18) after weight loss of ≥5% body weight with long term (≥12 months) follow-up of weight change (main outcome) were included. Study appraisal and synthesis Potential studies were screened independently and in duplicate; study characteristics and outcomes were extracted. Meta-analyses were conducted to estimate the effects of interventions on weight loss maintenance with the inverse variance method and a random effects model. Results are presented as mean differences in weight change, with 95% confidence intervals.
Results 45 trials involving 7788 individuals were included. Behavioural interventions focusing on both food intake and physical activity resulted in an average difference of −1.56 kg (95% confidence interval −2.27 to −0.86 kg; 25 comparisons, 2949 participants) in weight regain compared with controls at 12 months. Orlistat combined with behavioural interventions resulted in a −1.80 kg (−2.54 to −1.06; eight comparisons, 1738 participants) difference compared with placebo at 12 months. All orlistat studies reported higher frequencies of adverse gastrointestinal events in the experimental compared with placebo control groups. A dose-response relation for orlistat treatment was found, with 120 mg doses three times a day leading to greater weight loss maintenance (−2.34 kg, −3.03 to −1.65) compared with 60 mg and 30 mg three times a day (−0.70 kg, 95% confidence interval −1.92 to 0.52), P=0.02.
Conclusions Behavioural interventions that deal with both diet and physical activity show small but significant benefits on weight loss maintenance.
Intentional weight loss among overweight and obese adults (body mass index ≥ 25 kg/m(2)) 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.
Objectives:
To investigate the differences in the contributing factors involved in weight maintenance success and failure.
Design:
Semi-structured interviews were conducted with both successful and unsuccessful weight maintainers. Eighteen participants were recruited (16 women), nine of who had lost 10% of their body weight and maintained this weight for a minimum of 12 months (Maintainers), and nine individuals who met the above criteria for weight loss but had subsequently regained their weight (Regainers). A thematic analysis was employed to compare the differences between the two groups.
Results and conclusions:
Two main themes highlighted the differences between the two groups, these were: goal regulation and self-control. Within these overarching themes, successful weight maintenance was related to the following subthemes: long-term, realistic goal setting, consistent use of routines and self-monitoring, avoiding deprivation and effective coping skills. Unsuccessful maintenance was related to short-term unrealistic goal setting, inconsistent routines and self-monitoring, experiencing deprivation and poor coping skills. These factors are explained in terms of the interrelationships that they have on one another and their subsequent impact on weight maintenance success or failure.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
An introduction and explanation of the epistemological differences of
quantitative and qualitative research paradigms is first provided, followed
by an overview of the realist philosophical paradigm, which attempts to
accommodate the two. From this foundational discussion, the paper then
introduces the concept of meaning making in research methods and looks
at how meaning is generated from qualitative data analysis specifically.
Finally, some examples from the literature of how meaning can be
constructed and organized using a qualitative data analysis approach are
provided. The paper aims to provide an introduction to research
methodologies, coupled with a discussion on how meaning making
actually occurs through qualitative data analysis.
To develop more efficient programmes for promoting dietary and/or physical activity change (in order to prevent type 2 diabetes) it is critical to ensure that the intervention components and characteristics most strongly associated with effectiveness are included. The aim of this systematic review of reviews was to identify intervention components that are associated with increased change in diet and/or physical activity in individuals at risk of type 2 diabetes.
MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library were searched for systematic reviews of interventions targeting diet and/or physical activity in adults at risk of developing type 2 diabetes from 1998 to 2008. Two reviewers independently selected reviews and rated methodological quality. Individual analyses from reviews relating effectiveness to intervention components were extracted, graded for evidence quality and summarised.
Of 3856 identified articles, 30 met the inclusion criteria and 129 analyses related intervention components to effectiveness. These included causal analyses (based on randomisation of participants to different intervention conditions) and associative analyses (e.g. meta-regression). Overall, interventions produced clinically meaningful weight loss (3-5 kg at 12 months; 2-3 kg at 36 months) and increased physical activity (30-60 mins/week of moderate activity at 12-18 months). Based on causal analyses, intervention effectiveness was increased by engaging social support, targeting both diet and physical activity, and using well-defined/established behaviour change techniques. Increased effectiveness was also associated with increased contact frequency and using a specific cluster of "self-regulatory" behaviour change techniques (e.g. goal-setting, self-monitoring). No clear relationships were found between effectiveness and intervention setting, delivery mode, study population or delivery provider. Evidence on long-term effectiveness suggested the need for greater consideration of behaviour maintenance strategies.
This comprehensive review of reviews identifies specific components which are associated with increased effectiveness in interventions to promote change in diet and/or physical activity. To maximise the efficiency of programmes for diabetes prevention, practitioners and commissioning organisations should consider including these components.
Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3x/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight.
Evaluations of weight management programs in real-world settings are lacking. The RE-AIM model (reach, effectiveness, adoption, implementation, maintenance) was developed to address this deficiency. Our primary objective was to evaluate a 12-week insurance-sponsored weight management intervention by using the RE-AIM model, including short-term and long-term individual outcomes and setting-level implementation factors. Our secondary objective was to critique the RE-AIM model and its revised calculation methods.
We created operational definitions for components of the 5 RE-AIM indices and used standardized effect size values from various statistical procedures to measure multiple components or outcomes within each index. We used chi(2) analysis to compare categorical variables and repeated-measures analysis of variance to assess the magnitude of outcome changes over time.
On the basis of data for 1,952 participants and surveys completed by administrators at 23 sites, RE-AIM indices ranging from 0 to 100 revealed low program reach and adoption (5.4 and 8.8, respectively), moderate effectiveness (43.8), high implementation (91.4), low to moderate individual maintenance (21.2), and moderate to high site maintenance (77.8). Median (interquartile range) weight loss was 13 lb (6.5-21.4 lb) among participants who completed phase I (12 weeks; 76.5%) and 15 lb (6.1-30.3 lb) among those who completed phase II (1 year; 45.7%).
This program had a significant, positive effect on participants and has been sustainable but needs to be expanded for more public health benefit. The RE-AIM model provided a useful framework to determine program strengths and weaknesses and to present them to the insurance agency and public health decision makers.
The main purpose of this article was to investigate the value of a self-regulation approach for weight reduction interventions in patients with type 2 diabetes. In addition, the potentially moderating effect of other intervention characteristics was explored.
In a meta-analysis of 34 studies, overall effect sizes were calculated for weight and A1C. The focus of the analysis was, however, on the moderating effect of intervention characteristics, especially whether interventions that score high on self-regulation produce stronger effects.
The overall effect sizes (d) for weight loss in the short term (<6 months) were low and even lower in the longer term (>6 months). The overall effect sizes for A1C outcomes were higher and remained stable in the longer term. Interventions that scored high on self-regulation characteristics produced significantly better effects on both weight and A1C outcomes. Furthermore, "goal reformulation" increased the effect on weight outcomes whereas "emotion regulation" increased the effect on A1C. With respect to the other intervention characteristics, only the "inclusion of a patient's partner or relative" increased the effect on weight loss.
This meta-analysis underlines the importance of a self-regulation approach for weight reduction interventions in diabetes patients, in particular, for A1C outcomes. However, more research is needed to fully understand the relationship among self-regulation, weight, and A1C.
Stress and negative emotions have been shown to be critical factors in inducing overeating as a form of maladaptive coping in some patients with obesity. We evaluated the efficacy of a 3-week relaxation protocol enhanced by virtual reality and portable mp3 players in reducing emotional eating in a sample of 60 female inpatients with obesity who report emotional eating, using a three-arm exploratory randomized controlled trial with 3 months of follow-up. The intervention included 12 individual relaxation training sessions provided traditionally (imagination condition) or supported by virtual reality (virtual reality condition). Control participants received only standard hospital-based care. Weight, behavior and psychological data were collected and analyzed. Relaxation training was effective in reducing emotional eating episodes, depressive and anxiety symptoms, and in improving perceived self-efficacy for eating control at 3-month follow-up after discharge. The virtual reality condition proved better than the imagination condition in the reduction of emotional eating. Weight decreased in subjects in all three conditions without significant differences between them, probably due to the common treatment all inpatients received. We conclude that relaxation training supported by new technologies could be a useful tool for reducing emotional eating episodes and thereby reducing weight and obesity.
This study investigated perceptions of and engagement with the concepts of planning and problem-solving, within a weight management sample. A total of 53 participants (62% female, 20–74 years old) completed a semi-structured interview and quantitative measures after a 16-week weight maintenance period. Preliminary weight maintainers (who had maintained losses of, at least 10% of their original weight) were compared with heavier-than-baseline participants (who had re-gained more weight than was originally lost). The maintainers exhibited stronger problem-solving skills (p < .05). The heavier-than-baseline participants tended towards non-rational problem-solving styles. Qualitatively, the maintainers described more planning events and were more accepting of mistakes than the heavier-than-baseline participants. Implications are discussed.
The challenge of weight-loss maintenance is well known, but few studies have followed successful weight losers over an extended period or evaluated the effect of behavior change on weight trajectories.
To study the weight-loss trajectories of successful weight losers in the National Weight Control Registry (NWCR) over a 10-year period, and to evaluate the effect of behavior change on weight-loss trajectories.
A 10-year observational study of self-reported weight loss and behavior change in 2886 participants (78% female; mean age 48 years) in the NWCR who at entry had lost at least 30 lbs (13.6 kg) and kept it off for at least one year. Data were collected in 1993-2010; analysis was conducted in 2012.
Weight loss (kilograms; percent weight loss from maximum weight).
Mean weight loss was 31.3 kg (95% CI=30.8, 31.9) at baseline, 23.8 kg (95% CI=23.2, 24.4) at 5 years and 23.1±0.4 kg (95% CI=22.3, 23.9) at 10 years. More than 87% of participants were estimated to be still maintaining at least a 10% weight loss at Years 5 and 10. Larger initial weight losses and longer duration of maintenance were associated with better long-term outcomes. Decreases in leisure-time physical activity, dietary restraint, and frequency of self-weighing and increases in percentage of energy intake from fat and disinhibition were associated with greater weight regain.
The majority of weight lost by NWCR members is maintained over 10 years. Long-term weight-loss maintenance is possible and requires sustained behavior change.
Physical activity is critical in healthy weight loss, yet there is still much to be learned about psychosocial mechanisms of physical activity behavior change in weight loss. A sequential mixed methods approach was used to assess the physical and psychosocial impact of a 12-week cognitive—behavioral weight management program and explore factors associated with weight loss. Quantitative data (N = 55) revealed program completion rate and mean percentage weight loss that compare favorably with other interventions, and differential psychosocial impacts on those losing more weight. Telephone interviews (n = 11) revealed four potential mechanisms for these differential impacts: (a) fostering accountability, (b) balancing perceived effort and success, (c) redefining ‘‘success,’’ and (d) developing cognitive flexibility.
The major patterns of self-regulatory failure are reviewed. Underregulation occurs because of deficient standards, inadequate monitoring, or inadequate strength. Misregulation occurs because of false assumptions or misdirected efforts, especially an unwarranted emphasis on emotion. The evidence supports a strength (limited resource) model of self-regulation and suggests that people often acquiesce in losing control. Loss of control of attention, failure of transcendence, and various lapse-activated causes all contribute to regulatory failure.
L’autorégulation peut être définie comme un processus d’orientation vers un objectif visant l’atteinte et le suivi de buts personnels. Dans cet article, on distingue trois phases dans ce processus: 1) le choix d’un objectif, l’organisation et la représentation/interprétation; 2) la poursuite active du but; 3) l’atteinte et le suivi ou, au moment opportun, l’abandon du but. Ces trois phases servent de fil conducteur à ce texte. On présente pour chaque phase des outils d’évaluation et des interventions. L’article se termine par la description d’orientations pour de futures recherches concernant l’évaluation de l’autorégulation et les interventions, en retenant quinze principes d’intervention qui peuvent être exploités comme régles générales pour la mise en œuvre d’interventions dans la prise en charge des maladies chroniques et le développement d’une politique de santé.
Self-regulation can be defined as a goal-guidance process aimed at the attainment and maintenance of personal goals. In this article three phases are distinguished in this process: (a) goal selection, setting and construal/representation; (b) active goal pursuit; and (c) goal attainment and maintenance or, when appropriate, goal disengagement. These phases are used as a structure for the present review. For each phase, assessment instruments and interventions are described. The article concludes with directions for future research concerning self-regulation assessment and interventions, including 15 intervention principles which can be used as rules of thumb for the development of interventions in chronic illness management and in health promotion.
Obesity is remarkably refractory to treatment. Despite a plethora of quantitative studies, little qualitative research has been conducted on the topic of weight loss maintenance. This study used six focus groups to explore which factors promoted or prevented maintaining weight loss among a diverse, urban population. Eligible participants were those who had intentionally lost ≥10% of their body weight in the past 2 years and were categorized as either "regainers" or "maintainers" using self-reported length of weight maintenance and amount (%) regained. Regainers had regained ≥33% of their weight loss and maintainers had regained ≤15%. Participants (n=29) were predominantly African-American (58.6%) females (65.6%) with a mean age of 46.9±11.2 years. Four themes reflected similarities between regainers and maintainers, and four reflected differences between the groups. Both groups experienced lapses, used clothing fit for feedback on weight status, desired greater support during maintenance, and decreased self-monitoring of food intake over time. When compared with regainers, maintainers more often continued strategies used during weight loss, weighed themselves regularly, and used productive problem-solving skills and positive self-talk. Regainers experienced greater difficulty independently continuing food and exercise behaviors during maintenance, identifying decreased accountability and waning motivation as barriers. These findings suggest that weight loss maintenance efforts can be improved by addressing challenges such as long-term self-monitoring and problem-solving skills, and that maintenance success might depend on how people think as much as what they do.
To examine the long-term effects of multiple health-behavior changes from the Mediterranean Lifestyle Program.
The randomized trial targeted postmenopausal women with type 2 diabetes (N = 279) at high risk for heart disease. The intervention featured a weekend retreat followed by regular meetings over 24 months to enhance healthful eating, physical activity (PA), stress management, and support behaviors.
Long-term analyses indicated that significant improvements made in the targeted behaviors during the active treatment phase of the study (at 6, 12, and 24 months) were partially maintained during the nontreatment phase of the study, through 5 years postintervention contact for dietary behavior and stress management, and 1-year posttreatment for PA.
This moderate-intensity group-based intervention produced health behavior changes that tended to plateau or return to baseline levels 1 to 5 years after treatment.
The present qualitative study aims to explore the experiences of dieters who successfully maintain their weight loss with a focus on the transition in perception of self from their heaviest to their current reduced weight. Ten successful women from a slimming club who had lost at least 10 per cent of their weight for a minimum of one year participated in the study. The results showed an identity shift from a previous restrained self towards a liberated individual, regarding their social interactions, dietary habits, emotional regulation and self-appraisal. The results are discussed in terms of the process of reinvention and the impact of stigma on an obese person's self-identity.
Two studies investigated the stress-eating relationship. The first examined self-reported changes in intake of snack foods, whilst the second investigated stress-induced overconsumption in a laboratory setting comparing high (HF) and low-fat (LF) snacks. Eighty-nine females completed the Dutch Eating Behaviour Questionnaire (DEBQ) [Van Strien, T., Fritjers, J. E. R., Bergers, G. P. A., & Defares, P. B. (1986). Dutch Eating Behaviour Questionnaire for assessment of restrained, emotional and external eating behaviour. International Journal of Eating Disorders, 5, 295-315] and a self-report measure designed to evaluate changes in eating in response to stress. Increased intake of HF snacks was associated with high emotional eating but not with restraint. A laboratory-based experiment compared intake of HF and LF snacks after ego-threatening and neutral Stroop colour-naming tasks. Intake was suppressed by 31.8% in restrained compared to unrestrained eaters across tasks. Restrained eaters consumed significantly less after ego-threat than after the neutral manipulation, but this was associated only with intake of the LF snack. Restrained eaters' intake of dried fruit was suppressed by 33.2% after ego-threat relative to the neutral task, despite a significant increase in hunger for this group following ego-threat. These results suggest that the type and variety of foods offered influences the link between stress and eating in laboratory settings. Further research should aim to replicate and extend these findings, with a view to informing potential interventions for stress-related eating.
Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes.
We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups.
The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin.
Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
To investigate, among women with obesity who have lost weight, the psychological factors associated with successfully maintaining the new lower weight, as opposed to weight regain.
Qualitative research methods (in-depth individual interviews and group interviews) were used to assess the characteristics of successful weight maintainers, as compared with weight regainers and healthy-weight women.
In all, 76 females were recruited from the community, comprising 28 formerly obese women who had lost weight and maintained their new lower weight for at least 1 y; 28 obese women who had lost weight but regained the weight that they had lost; and 20 women with a stable weight in the healthy range.
Certain psychological factors were identified which characterised the regainers but not the maintainers. These factors were: failure to achieve weight goals and dissatisfaction with the weight achieved; the tendency to evaluate self-worth in terms of weight and shape; a lack of vigilance with regard to weight control; a dichotomous (black-and-white) thinking style; and the tendency to use eating to regulate mood.
The results suggest that psychological factors may provide some explanation as to why many people with obesity regain weight following successful weight loss. The factors identified in this study need to be examined further using prospective designs.
It is a consistent finding that, among obese patients, the weight lost as a result of the most widely available treatments for obesity is almost always regained. This relapse appears to be attributable to the individual's inability to persist with the behavioural strategies needed to maintain the new lower weight. Little research has investigated the psychological mechanisms that might account for this phenomenon. This study aimed to identify psychological factors that predict weight regain. Fifty-four women with obesity who had lost weight by attending community slimming clubs were interviewed immediately after losing 10% of their initial body weight, and then followed-up every 2 months for a period of 1 year by means of telephone interviews. The results identified two prospective predictors of weight regain: one cognitive factor (dichotomous thinking) and one historical variable (maximum lifetime weight). The finding that a specific cognitive style is a significant predictor of relapse has implications for the treatment of obesity.
Relatively few studies have focused on who is at risk for weight regain after weight loss and how to prevent it. The objectives of this study were to determine the prevalence and predictors of weight regain in U.S. adults who had experienced substantial weight loss.
Data were analyzed from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). This study examined U.S. adults aged 20-84 years who were overweight or obese at their maximum weight (body mass index >/=25) and had experienced substantial weight loss (weighed 10% less than their maximum weight 1 year before they were surveyed) (n=1310).
Compared to their weight 1 year ago, 7.6% had continued to lose weight (>5%), 58.9% had maintained their weight (within 5%), and 33.5% had regained weight (>5%). Factors associated with weight regain (vs weight maintenance or loss) included Mexican American ethnicity (versus non-Hispanic white) (odds ratio [OR]=2.0; 95% confidence interval [CI]=1.3-3.1), losing a greater percentage of maximum weight (>/=20% vs 10% to <15%) (OR=2.8; 95% CI=2.0-4.1), having fewer years since reaching maximum weight (2-5 years vs >10 years) (OR=2.1; 95% CI=1.2-3.7), reporting greater daily screen time (>/=4 hours vs 0-1 hour) (OR=2.0; 95% CI=1.3-3.2), and attempting to control weight (OR=1.8; 95% CI=1.1-3.0). Finally, weight regain was higher in those who were sedentary (OR=1.8; 95% CI=1.0-3.0) or not meeting public health recommendations for physical activity (OR=2.0; 95% CI=1.2-3.5).
How to achieve the skills necessary for long-term maintenance of weight loss in the context of an obesogenic environment remains a challenge.
The disinhibition scale of the Eating Inventory predicts weight loss outcome; however, it may include multiple factors. The purpose of this study was to examine the factor structure of the disinhibition scale and determine how its factors independently relate to long-term weight loss outcomes.
Exploratory factor analysis of the disinhibition scale was conducted on 286 participants in a behavioral weight loss trial (TRIM), and confirmatory factor analysis was conducted on 3,345 members of the National Weight Control Registry (NWCR), a registry of successful weight loss maintainers. Multivariate regressions were used to examine the relationships between the disinhibition scale factors and weight over time in both samples.
Using baseline data from TRIM, two factors were extracted from the disinhibition scale: 1) an "internal" factor that described eating in response to internal cues, such as feelings and thoughts; and 2) an "external" factor that described eating in response to external cues, such as social events. This factor structure was confirmed using confirmatory factor analysis in the NWCR. In TRIM, internal disinhibition significantly predicted weight loss at 6 months (p = 0.03) and marginally significantly predicted weight loss at 18 months (p = 0.06), with higher levels of internal disinhibition at baseline predicting less weight loss; external disinhibition did not predict weight loss at any time-point. In NWCR, internal disinhibition significantly predicted one-year weight change (p = 0.001), while external disinhibition did not.
These results suggest that it is the disinhibition of eating in response to internal cues that is associated with poorer long-term weight loss outcomes.
). (Health E-Stats) (p. 6). National Center for Health Statistics
- C D Fryar
- M D Carroll
- C L Ogden