Improvements in Maternal Cardiovascular Health Over the Perinatal Period Longitudinally Predict Lower Postpartum Psychological Distress Among Individuals Who Began Their Pregnancies With Overweight or Obesity.

BACKGROUND: Adverse cardiovascular events during pregnancy (eg, preeclampsia) occur at higher rates among individuals with overweight or obesity (body mass index ≥25 kg/m2) and have been associated with postpartum depression. The present study examined whether changes in cardiovascular health (CVH) during the perinatal period, as defined by the American Heart Association's Life's Essential 8 framework, predicted postpartum psychological functioning among individuals with prepregnancy body mass index ≥25 kg/m2. METHODS AND RESULTS: Pregnant individuals (N = 226; mean ± SD age = 28.43 ± 5.4 years; mean body mass index = 34.17 ± 7.15 kg/m2) were recruited at 12 to 20 weeks of gestation (mean, 15.64 ± 2.45 weeks) for a longitudinal study of health and well-being. Participants completed ratings of depression and perceived stress and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6 months postpartum. Body mass index and CVH behaviors were used to calculate a composite CVH score at both time points. Linear regression analyses were performed to examine whether change in CVH related to postpartum symptom scores. Because sleep was measured in only a subset of participants (n = 114), analyses were conducted with and without sleep. Improved CVH was associated with lower postpartum depression (ß = -0.18, P<0.01) and perceived stress (ß = -0.13, P=0.02) scores. However, when including sleep, these relationships were no longer significant (all P>0.4). CONCLUSIONS: Improvements in CVH from early pregnancy to 6 months postpartum were associated with lower postpartum depressive symptoms and perceived stress but not when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.

Mindfulness in Pregnancy and Postpartum: Protocol of a Pilot Randomized Trial of Virtually Delivered Mindfulness-Based Cognitive Therapy to Promote Well-Being during the Perinatal Period.

BACKGROUND: During the period from pregnancy through the first year postpartum, vulnerable individuals are at elevated risk for the onset or worsening of psychological distress, and accessible (e.g., virtually delivered) mental health interventions are needed. Research suggests that Mindfulness-Based Cognitive Therapy (MBCT) can effectively mitigate psychological distress, although few studies have evaluated MBCT in the perinatal period, and samples have been clinically homogenous. Thus, we have designed and are conducting a pilot trial of virtually delivered MBCT with pregnant individuals experiencing a range of psychological symptoms to assess its feasibility and preliminarily explore its effectiveness. Here, we present the study protocol. METHODS: Eligible participants (target N = 70) are ≥18 years with pregnancies between 12 and 30 weeks of gestation. Participants complete a diagnostic interview, self-report symptom ratings, and a computerized cognitive battery assessing self-regulation at the baseline. Participants are then randomized to either MBCT or care as usual. The MBCT intervention involves eight weekly group sessions delivered virtually, with each session focusing on a mindfulness practice followed by group discussion and skill development. Participants in the intervention group are also encouraged to practice mindfulness skills between sessions. Participants in the control condition are provided with information about mindfulness and treatment resources. Baseline measures are repeated following the eight-week intervention period and at three months postpartum. CONCLUSIONS: This pilot study is designed to evaluate the feasibility of virtually delivered MBCT and explore group differences in psychological symptoms during the perinatal period, and will lay the foundation for a larger clinical trial focused on optimizing this intervention to improve psychological functioning among diverse pregnant individuals.

Associations between prenatal loss of control eating and cardiovascular health during pregnancy.

OBJECTIVE: Loss of control (LOC) eating (feeling unable to control food type/amount eaten) during pregnancy is common and linked to risk for poor cardiovascular health (CVH), but it is unclear whether prenatal LOC eating directly relates to CVH during pregnancy. The current study tested associations between prenatal LOC eating and CVH during pregnancy in a sample with prepregnancy body mass index (BMI) ≥ 25. METHOD: At 12-20 weeks' gestation, participants (N = 124) self-reported: prenatal LOC eating, diet, physical activity, nicotine use, sleep; height/weight were measured. Data were collected during 2015-2017. We dichotomized LOC eating (0 = absent; 1 = present) and scored CVH metrics using Life's Essential 8 to create a composite CVH score (range = 0-100; higher = better). Linear and binary logistic regression models tested if LOC eating is related to composite CVH score and odds of scoring low (0)/moderate-high (1) on each CVH metric, respectively. All models employed propensity score adjustment, since those with/without LOC eating may differ in ways affecting CVH, and covaried for: age, gestational age, prepregnancy BMI, ethnicity, race, education, and income. RESULTS: Compared to those without, participants with LOC eating had significantly poorer composite CVH scores (b = -9.27, t(111) = -2.70, p < .01) and lower odds of scoring moderate-high on nicotine use (OR = 0.20, 95% CI [0.04, 0.85], p = .03) and sleep duration (OR = 0.19, 95% CI [0.04, 0.83], p = .03) CVH metrics. CONCLUSIONS: Prenatal LOC eating was associated with poorer CVH during pregnancy in this sample with prepregnancy BMI ≥ 25, even after controlling for propensity of experiencing LOC eating and known risk factors for poor CVH. Thus, prenatal LOC may represent a modifiable factor related to prenatal health risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A longitudinal investigation of breastfeeding planning, initiation, and duration among individuals with pre-pregnancy overweight or obesity.

Individuals with a body mass index (BMI)≥25 kg/m2 are less likely to initiate and continue breastfeeding than are those with BMIs<25. Given the intergenerational health benefits of breastfeeding, it is important to understand breastfeeding behaviors and their correlates among individuals with BMIs≥25. Thus, in an observational cohort with BMI≥25 (N = 237), we aimed to characterize longitudinal relationships among breastfeeding planning, initiation, and duration and their sociodemographic/clinical correlates and determine if pre-pregnancy BMI predicts breastfeeding planning, initiation, and duration. Breastfeeding behaviors, weight/BMI, and sociodemographic/clinical characteristics were assessed in early, mid, and late pregnancy, and at six-months postpartum. Most participants planned to (84%) and initiated (81%) breastfeeding, of which 37% breastfed for ≥6 months. Participants who were married, first-time parents, higher in education/income, and had never smoked tobacco were more likely to plan, initiate, and achieve ≥6 months of breastfeeding. Higher pre-pregnancy BMI was not associated with breastfeeding planning or initiation but was associated with lower adjusted odds of breastfeeding for ≥6 months relative to <6 months. Findings suggest that support aimed at extending breastfeeding among those with elevated pre-pregnancy BMI may be warranted. Future interventions should also address sociodemographic and clinical inequities in breastfeeding.

Furthering development of the Eating Disorder Examination-Pregnancy Version (EDE-PV): Exploratory factor analysis and psychometric performance among a community sample of pregnant individuals with body mass index ≥ 25.

Psychometrically sound measures of disordered eating during pregnancy are needed, particularly for pregnant individuals with body mass index (BMI) ≥ 25, who are at high risk for disordered eating attitudes/behaviors. We previously adapted the Eating Disorder Examination (EDE) for use among pregnant individuals with BMI ≥ 25. This study examined the factor structure of the EDE-Pregnancy Version (EDE-PV) in a community sample of pregnant individuals with BMI ≥ 25. The EDE-PV was administered to 257 pregnant individuals with pre-pregnancy BMI ≥ 25 between 12 and 20 weeks gestation. The EDE-PV factor structure was determined using an exploratory factor analysis with oblique geomin rotation, internal consistency coefficients were calculated, and convergent and discriminant validity of the EDE-PV factors were assessed. An 11-item, two-factor solution produced an acceptable model fit. The subscales did not replicate those of the EDE and were interpreted as Pregnancy Eating and Weight Change Concerns and Pregnancy Shape and Weight Concerns (αs=.67 and .85; ωs=.70 and .85, respectively). These subscales showed small-to-moderate, positive correlations with weight and psychosocial distress measures and differentiated between participants with and without lifetime histories of any eating disorder diagnosis, demonstrating adequate convergent and discriminant validity. The results indicate that the EDE-PV can more reliably identify factors associated with disordered eating attitudes/behaviors among pregnant individuals with BMI ≥ 25 compared to the EDE and support our call for the development and use of new and/or adapted measures to appropriately assess disordered eating during pregnancy.

Real Change or Performative Anti-Racism? Clinical Psychology Programs' Efforts to Recruit and Retain BIPOC Scholars.

OBJECTIVE: This study assessed perceptions of Clinical Psychology doctoral programs' efforts to recruit and retain faculty and graduate students of color, as well as differences in perceptions based on participants' position within their program (i.e. graduate student versus faculty) and race. METHOD: Participants (n = 297; 35% people of color; 79% female; mean age: 32) were graduate students and faculty from Clinical Psychology doctoral programs who completed an anonymous online survey about their programs' efforts to recruit and retain graduate students and faculty of color; sense of belonging and perceptions of racial discrimination within programs; and experiences of cultural taxation and racism within programs. RESULTS: Faculty (n = 95) reported significantly greater perceptions of recruitment and retention efforts and fewer perceptions of racial discrimination than did graduate students (n = 202). Asian (n = 31), Black (n = 25), and Latinx (n = 35) participants reported significantly fewer perceptions of recruitment and retention efforts, less sense of belonging, and greater perceptions of racial discrimination than did White participants (n = 192). Cultural taxation was common among participants of color, and approximately half (47%) reported they have considered leaving academia - and approximately one third (31%) have considered leaving their program - due to experiences of racism in their program or field. CONCLUSIONS: Cultural taxation and racial discrimination were common among scholars of color in this sample. Whether intentional or not, these experiences contribute to racially-toxic environments and negatively impact the racial diversity of the mental health workforce.

Disordered eating during pregnancy among individuals participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

BACKGROUND: Food insecurity is associated with adverse psychosocial and health consequences in pregnancy. In non-pregnant populations, evidence suggests that food insecurity is linked to eating pathology, independent of depression or anxiety. Food assistance programs intended to reduce food insecurity, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), may unintentionally contribute to eating pathology through a "feast-or-famine" cycle (i.e., cyclical periods of food deprivation and food access over the benefit month). Thus, the present study examined associations between WIC participation and disordered eating in pregnancy, covarying for depressive symptoms. METHODS: The present study is a secondary analysis of the Pittsburgh Girls Study (PGS), a 21-year prospective longitudinal study that over-sampled households in low resourced neighborhoods. The present analysis included a subset of pregnant PGS participants (N = 210; 13-25 years of age) who reported on WIC participation, and disordered eating and depressive symptoms on validated measures. RESULTS: Negative binomial regression models covarying for participant's age at conception and gestational age at assessment found that WIC participation was associated with higher scores on overall eating pathology as well as dieting and oral control subscales, but not bulimic or food preoccupation subscales, or a binge-eating item. Patterns of findings did not change when depressive symptom severity was included in models. DISCUSSION: WIC participation was associated with eating pathology during pregnancy. Future research should clarify directional relationships among food insecurity, food assistance, and eating behavior in pregnancy to promote health equity.

An Ethics and Social-Justice Approach to Collecting and Using Demographic Data for Psychological Researchers.

The collection and use of demographic data in psychological sciences has the potential to aid in transforming inequities brought about by unjust social conditions toward equity. However, many current methods surrounding demographic data do not achieve this goal. Some methods function to reduce, but not eliminate, inequities, whereas others may perpetuate harmful stereotypes, invalidate minoritized identities, and exclude key groups from research participation or access to disseminated findings. In this article, we aim to (a) review key ethical and social-justice dilemmas inherent to working with demographic data in psychological research and (b) introduce a framework positioned in ethics and social justice to help psychologists and researchers in social-science fields make thoughtful decisions about the collection and use of demographic data. Although demographic data methods vary across subdisciplines and research topics, we assert that these core issues-and solutions-are relevant to all research within the psychological sciences, including basic and applied research. Our overarching aim is to support key stakeholders in psychology (e.g., researchers, funding agencies, journal editors, peer reviewers) in making ethical and socially-just decisions about the collection, analysis, reporting, interpretation, and dissemination of demographic data.

Improvements in cardiovascular health over the perinatal period predicts lower postpartum psychological distress.

Background: Adverse cardiovascular events during pregnancy (e.g., pre-eclampsia) occur at higher rates among individuals with pre-pregnancy overweight or obesity (body mass index [BMI]≥25kg/m2) and have been associated with postpartum depression. However, it is unclear whether cardiovascular health (CVH), defined more holistically than the absence of cardiovascular conditions in pregnancy, relates to postpartum psychological functioning. The present study examined whether changes in CVH during the perinatal period predicted postpartum psychological functioning among individuals with pre-pregnancy BMI≥25kg/m2. Methods: Individuals (N=226; Mage=28.43±5.4 years; MBMI=34.17±7.15kg/m2) were recruited when their pregnancies were 12-20 weeks gestation (M=15.64±2.45 weeks) for a longitudinal study of health and well-being. Participants completed the Center for Epidemiological Studies Depression Scale (CES-D) and Perceived Stress Scale (PSS) and reported on CVH behaviors (dietary intake, physical activity, nicotine exposure, and sleep) at baseline and at 6-months postpartum. BMI and CVH behaviors were coded according to the American Heart Association's Life's Essential 8 to create a CVH score at both timepoints. Linear regression analyses were performed to examine whether change in CVH related to postpartum CES-D and PSS scores. Because sleep was only measured in a subset of participants (n=114), analyses were conducted with and without sleep included. Baseline CVH, CES-D and PSS scores, and demographic factors were included as covariates in all models. Results: Improved CVH was associated with lower postpartum CES-D (ß=-0.18, p<0.01) and PSS (ß=-0.13, p=0.02) scores when excluding sleep. Compared to those whose CVH improved by >1SD from pregnancy to 6-months postpartum, individuals whose CVH worsened by >1SD scored 6.42 points higher on the CESD (MCESD=15.25±10.92 vs. 8.52±6.90) and 6.12 points higher on the PSS (MPSS=24.45±8.29 vs. 17.83±8.70). However, when including sleep, these relationships were no longer significant (ps>0.4). Conclusions: Improvements in CVH from early pregnancy to 6-months postpartum were associated with lower postpartum depressive symptoms and perceived stress. However, these relationships were no longer significant when including sleep in the CVH metric, potentially due to the large reduction in sample size. These data suggest that intervening during pregnancy to promote CVH may improve postpartum psychological functioning among high-risk individuals.

Culturally Responsive Telepsychology & mHealth Interventions for Racial-Ethnic Minoritized Youth: Research Gaps and Future Directions.

Telepsychology and mHealth (TPmH) services for youth and their families have become increasingly prevalent in recent years. However, significant limitations in theory, research, and policy introduce questions about the effectiveness of such interventions, particularly for racial-ethnic minoritized youth and their families, who already contend with inequities in mental health treatment access and outcomes. Although TPmH have the potential to reduce barriers to mental health services in ways that may benefit racial-ethnic minoritized youth and their families, the mental health field must first grapple with limitations in culturally responsive TPmH work to avoid perpetuating existing mental health inequities. As such, this article begins by briefly reviewing extant literature on (1) TPmH for youth, (2) culturally adapted or culturally responsive evidence-based interventions for racial-ethnic minoritized youth and families, and (3) the intersection of TPmH and culturally responsive interventions. Informed by the gaps identified by this review, we provide recommendations for future directions in culturally responsive TPmH for racial-ethnic minoritized youth and families. These recommendations have been organized into four overarching categories: (1) conceptual and theoretical recommendations, (2) research priorities, (3) practice and policy recommendations, and (4) engagement and access recommendations. These recommendations offer novel ideas for researchers, clinicians, funding agencies, policy-makers, and other key stakeholders and are intended to facilitate equity in TPmH for racial-ethnic minoritized youth and their families.

The Relation of Grit to Weight Loss Maintenance Outcomes.

Biological, genetic, and environmental factors make weight loss very difficult. Acceptance-based behavioral treatment (ABT) supplements standard behavioral treatments (BT) for obesity by teaching skills to accept the discomfort inherent to weight control behaviors and prioritize long-term, values-based goals. Grit, the ability to persevere in goal pursuit, overlaps conceptually with ABT principles and may predict outcomes in ABT. During a randomized controlled trial comparing three weight loss interventions (BT, BT with an emphasis on physical activity [BT+PA], ABT with an emphasis on physical activity [ABT+PA]), this study examined if grit predicted weight loss, intervention engagement (session attendance and dietary self-monitoring), and perceived intervention effectiveness, and whether intervention condition moderated these relationships. Participants (N=309) with overweight/obesity enrolled in an 18-month weight loss intervention completed the Short Grit Scale at baseline. Weight and PA were measured at baseline, during the intervention (12 and 18 months), and at follow-up (24 and 36 months). Session attendance and dietary self-monitoring were assessed throughout the intervention, and perceived intervention effectiveness at end-of-intervention. The relation of grit to several outcomes depended on condition. In ABT+PA, but not BT or BT+PA, lower grit related to higher weight loss at 12 and 24 months, session attendance, and perceived intervention effectiveness. Grit was not related to PA or dietary self-monitoring in any condition. ABT's focus on building skills to facilitate long-term goal pursuit may be unique and beneficial to those with lower grit. Those with higher grit may already possess ABT-consistent skills and benefit less from ABT. Research on trait-level characteristics like grit in relation to weight must be cautious not to reinforce weight bias; rather, this work suggests that an evidence-based intervention (ABT) may be well-suited to those with lower grit levels seeking weight loss.

Examining weight suppression as a predictor and moderator of intervention outcomes in an eating disorder and obesity prevention trial: A replication and extension study.

Weight suppression (WS) predicts future weight gain and increases in eating disorder symptoms in community and clinical samples but has received minimal attention in obesity and eating disorder prevention programs. In a sample of emerging adults (N = 364) in a randomized controlled trial evaluating two obesity and eating disorder prevention interventions versus a control condition, this study aimed to replicate the findings that WS and its interaction with baseline BMI predict increases in weight and eating disorder symptoms and test a novel hypothesis that WS would moderate the effects of the interventions on change in weight and eating disorder symptoms. Participants completed assessments at baseline, post-intervention, 6-, 12-, and 24-months. WS was calculated as the difference between highest lifetime weight and baseline weight. WS interacted with baseline BMI to predict greater weight gain over 24-months, such that those with high WS and lower baseline BMI gained weight most rapidly. WS did not predict eating disorder symptom change and did not moderate the effects of the prevention programs. Given that individuals with WS are at increased risk for weight gain, expressly targeting this high-risk population with evidence-based obesity prevention programs may be useful. CLINICALTRIALS.GOV REGISTRATION: NCT01680224.

Promotion of physical activity during weight loss maintenance: A randomized controlled trial.

OBJECTIVE: Behavioral weight loss (BWL) programs are not sufficiently effective at promoting high levels of moderate-to-vigorous physical activity (MVPA), despite the clear health benefits of exercise and the possibility that high levels of MVPA may improve long-term weight loss. This three-arm randomized controlled trial tested the hypotheses that 1) BWL interventions with an intensive focus on exercise would result in higher amounts of MVPA and greater long-term weight loss, compared to standard BWL, and 2) among interventions with an intensive focus on exercise, outcomes would be superior when skills for exercise promotion were taught from an acceptance-based theoretical framework (which fosters willingness to accept discomfort in the service of valued behaviors), versus a traditional behavioral approach. METHOD: Three hundred and twenty adults with overweight/obesity received group-based BWL for induction of weight loss (Months 1-6) and were randomized to receive one of three interventions for weight loss maintenance (Months 7-18): continued standard behavioral treatment (BT), behavioral treatment with an emphasis on exercise (BT + PA), or acceptance-based treatment with an emphasis on exercise (ABT + PA). RESULTS: MVPA and percent weight loss did not significantly differ by condition at 12 or 18 months. Participants engaging in relatively higher levels of MVPA had greater long-term weight losses compared to participants engaging in lower levels of MVPA. CONCLUSIONS: Further clinical innovations are needed so that participants in BWL programs can more readily adopt and maintain the recommended amounts of MVPA. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Comprehensive Cognitive-Behavioral Interventions Augment Diaphragmatic Breathing for Rumination Syndrome: A Proof-of-Concept Trial.

BACKGROUND: Rumination syndrome (RS) is often treated in medical settings with 1-2 sessions of diaphragmatic breathing to target reflexive abdominal wall contraction in response to conditioned cues (e.g., food). However, many patients remain symptomatic and require additional behavioral interventions. AIMS: In an attempt to augment diaphragmatic breathing with additional interventions, we tested the proof-of-concept of a comprehensive Cognitive-Behavioral Therapy (CBT) for RS. METHODS: In an uncontrolled trial, adults with RS completed a 5-8 session CBT protocol, delivered by one of two psychology behavioral health providers. CBT included two main phases: awareness training and diaphragmatic breathing (Phase 1) and modularized interventions chosen by the therapist and patient to target secondary maintenance mechanisms (Phase 2). At pre-treatment, post-treatment, and 3-month follow-up, participants completed a semi-structured interview on RS symptoms with an independent evaluator. RESULTS: Of 10 eligible individuals (ages 20-67 years, 50% female) offered treatment, all 10 initiated treatment and eight completed it. All participants endorsed high treatment credibility at Session 1. Permutation-based repeated measures ANOVA showed participants achieved large reductions in regurgitations across treatment [F(1,7) = 17.7, p = .007, η p2 = .69]. Although participants reduced regurgitations with diaphragmatic breathing during Phase 1, addition of other CBT strategies in Phase 2 produced further large reductions [F(1,7) = 6.3, p = .04, η p2 = .47]. Of eight treatment completers, treatment gains were maintained at 3-month follow-up for n = 6. CONCLUSIONS: Findings provide evidence of feasibility, acceptability, and proof-of-concept for a comprehensive CBT for RS that includes interventions in addition to diaphragmatic breathing to target secondary maintenance mechanisms. Randomized controlled trials are needed.

Perceived barriers to physical activity during and after a behavioural weight loss programme.

BACKGROUND: Most adults with overweight/obesity participating in behavioural weight loss (BWL) programmes never achieve prescribed physical activity (PA) levels. This study examined changes in PA barriers, their relationships with accelerometer-measured PA during and after a 12-month BWL programme, and associations between PA barriers and participant characteristics. METHODS: Adults (N = 283) in a BWL programme completed the Barriers to Being Active Quiz, a 21-item self-report measure that assesses seven perceived PA barriers, and they wore an accelerometer for seven consecutive days at baseline and at 6 (midtreatment), 12 (end of treatment), 18 (6-mo follow-up), and 24 months (12-mo follow-up). Weight and height were measured, and demographic information was collected at baseline. RESULTS: Repeated-measures analyses of variance (ANOVAs) revealed a significant quadratic effect of time on total PA barriers, P < .001, such that PA barriers decreased by midtreatment, remained below baseline levels by end of treatment, but increased to near-baseline levels by follow-up. Perceived PA barriers were negatively associated with baseline moderate-to-vigorous PA (MVPA), P < .001, and decreases in perceived PA barriers were related to greater MVPA at 6 (P = .004), 12 (P < .001), and 24 months (P = .007). Participants who were younger, P = .02, and white, P = .009, reported more baseline barriers. CONCLUSIONS: Perceived PA barriers meaningfully decreased during BWL treatment, which in turn was associated with greater MVPA. This pattern suggests that, on average, BWL effectively addresses perceived PA barriers, which contributes to increased PA. Future research should identify interventions to maintain decreases in barriers after end of treatment.

I think therefore I Am? Examining the relationship between exercise identity and exercise behavior during behavioral weight loss treatment.

OBJECTIVES: Identification as an exerciser may promote physical activity. This study examined exercise identity (EI) and its relationship with demographic characteristics and exercise among adults participating in behavioral weight loss treatment, which is a key target population for increasing exercise. DESIGN: Longitudinal. METHOD: Participants (N = 320) completed a measure of EI and exercise was assessed with accelerometers at baseline and 6 months. RESULTS: Baseline EI and exercise were positively related and EI and exercise increased over time. However, change in EI was not meaningfully related to change in exercise, baseline EI did not predict change in exercise, and 6-month EI was not related to 6-month exercise. Participants identifying as non-White reported greater EI but lower exercise. CONCLUSIONS: Although EI and exercise may increase among weight loss participants, the two may not be meaningfully related during active weight loss treatment. The relationship between EI and exercise may also differ based on race.

The relationship of weight suppression to treatment outcomes during behavioral weight loss.

Many adults enter behavioral weight loss (BWL) programs at a weight below their highest lifetime weight. The discrepancy between highest lifetime weight and current weight is known as weight suppression (WS). Research has yet to characterize WS during BWL or investigate its relation to weight loss outcomes or treatment acceptability. Adults (N = 272) in a 12-month BWL program were assessed. WS was calculated by subtracting measured baseline weight from self-reported highest lifetime weight. Participants with higher WS lost significantly less weight than those with lower WS during treatment, although they still had clinically meaningful weight losses (e.g., participants with WS above the median: 7.8 kg; participants with WS below the median: 12.0 kg). WS was unrelated to weight losses at 24-month follow-up. Controlling for weight loss, treatment acceptability was unrelated to WS. BWL appears appropriate for those with high WS, but future research should aim to improve outcomes in this group.

Participant and interventionist perceptions of challenges during behavioral weight loss treatment.

No prior studies have examined how interventionists' perceptions of participants' weight control challenges or the agreement between participants and interventionists on these perceptions relate to outcomes during group-based behavioral weight loss treatment. This study characterized participants' and interventionists' perceptions of, and agreement about, weight control challenges and assessed how these factors relate to weight loss. Three months into treatment, participants and interventionists independently selected three weight control challenges believed to be most relevant for each participant. Weight was measured at baseline, 3 months, and 12 months. Interventionists and participants had "no" (κ < 0) or "slight" (0 < κ< .20) agreement on most challenges. Although endorsement of certain challenges by participants and/or interventionists was related to 3- and 12-month weight losses, agreement between participants and interventionists was unrelated to weight loss at either time point. Additional research is needed to better understand the role of perceived challenges and participant/interventionist agreement about challenges on treatment outcomes.

Examination of Nutrition Literacy and Quality of Self-monitoring in Behavioral Weight Loss.

Background: Few have examined nutrition literacy (i.e., capacity to process and make informed nutritional decisions) in behavioral weight loss. Nutrition literacy (NL) may impact necessary skills for weight loss, contributing to outcome disparities. Purpose: The study sets out to identify correlates of NL; evaluate whether NL predicted weight loss, food record completion and quality, and session attendance; and investigate whether the relations of race and education to weight loss were mediated by NL and self-monitoring. Methods: This is a secondary analysis of 6-month behavioral weight loss program in which overweight/obese adults (N = 320) completed a baseline measure of NL (i.e., Newest Vital Sign). Participants self-monitored caloric intake via food records. Results: NL was lower for black participants (p < .001) and participants with less education (p = .002). Better NL predicted better 6-month weight loss (b = -.63, p = .04) and food record quality (r = .37, p < .001), but not food record completion or attendance (ps > 0.05). Black participants had lower NL, which was associated with poorer food record quality, which adversely affected weight loss. There was no indirect effect of education on weight loss through NL and food record quality. Conclusions: Overall, results suggest that lower NL is problematic for weight loss. For black participants, NL may indirectly impact weight loss through quality of self-monitoring. This might be one explanation for poorer behavioral weight loss outcomes among black participants. Additional research should investigate whether addressing these skills through enhanced treatment improves outcomes. Clinical trial information: NCT02363010.