Understanding the selection of support partners in a behavioral weight loss program.

OBJECTIVE: Engaging a support partner during behavioral weight loss (BWL) programs can improve outcomes. However, little information is available about those selected as support partners. The study aimed to (1) characterize support partners and qualities of the relationship, (2) assess differences in relationship dynamics across relationship types, and (3) assess differences in supportive relationships by participant gender. METHODS AND MEASURES: Upon entering a 24-month BWL program, participants (N = 323) nominated a support person from their existing social networks. Participants completed self-report measures at baseline, including the Working Alliance Inventory and study-specific measures assessing characteristics of the support person and comfort in communicating with them. RESULTS: Spouse/partners were chosen by 43.3% of all participants. Among married participants, 80.9% of men and 53.8% of women chose their spouse/partner. Working alliance was lower when the support partner was a spouse/partner versus a friend (p < 0.05, r = -0.19). Comfort talking about exercise with a support partner was higher than talking about eating or weight (p < 0.001, η2p= 0.05). CONCLUSION: A variety of friends and family can be selected as support partners during BWL. Programs should attend to the unique needs of men versus women when identifying sources of support.

Psychological and behavioral responses to daily weight gain during behavioral weight loss treatment.

Self-weighing is consistently associated with more effective weight control. However, patterns show that participants disengage from their weight control behaviors following weight gain. Women with BMIs in the overweight/obese range (N = 50) enrolled in a long-term behavioral weight loss program completed ecological momentary assessment (EMA) surveys immediately after their daily weigh-ins. Nightly EMA surveys and self-monitoring data through Fitbit measured their weight control behavior that day. On days when participants gained weight (vs. lost or maintained), they reported more negative mood, more guilt/shame, and lower confidence in weight control. Motivation following daily weight gain depended on participants' overall satisfaction with their weight loss so far: more satisfied participants had marginally higher, but less satisfied participants had marginally lower motivation in response to daily weight gain. Greater guilt/shame and lower motivation after the weigh-in predicted less effective weight control behavior that day (e.g., lower likelihood of calorie tracking, fewer minutes of physical activity). Results demonstrate that even small weight gain is distressing and demoralizing for women in BWL programs, which can lead to goal disengagement. These findings have implications for future BWL interventions, including the potential utility of just-in-time adaptive interventions to promote more adaptive responses in the moments after weigh-ins.

A Proof-of-Concept Pilot Test of a Behavioral Intervention to Improve Adherence to Dietary Recommendations for Cancer Prevention.

OBJECTIVES: Prevention programs that can help adults improve the quality of their diets to reduce cancer risk are needed. This Phase IIa study prospectively tested a mHealth intervention designed to improve adherence to dietary quality guidelines for cancer prevention. METHODS: All participants (N = 62) received nutrition education and a self-regulation skills curriculum, with a primary target of changing grocery shopping behavior. Using a randomized, factorial design, the study varied whether each of the following 4 components were added to the 20-week intervention: (1) location-triggered app messaging, delivered when individuals arrived at grocery stores, (2) reflections on benefits of change, delivered with extra coaching time and tailored app messages, (3) coach monitoring, in which food purchases were digitally monitored by a coach, and (4) involvement of a household member in the intervention. RESULTS: Benchmarks were successfully met for recruitment, retention, and treatment acceptability. Across conditions, there were significant reductions in highly processed food intake (P < .001, η2 = .48), red and processed meat intake (P < .001, η2 = .20), and sugar-sweetened beverage intake (P = .008, η2 = .13) from pre-to post-treatment. Analyses examining whether each intervention component influenced change across time found that participants who received coach monitoring increased their intake of fruits, vegetables, and fiber, whereas those with no coach monitoring had less improvement (P = .01, η2 = .14). The improvement in red and processed meat was stronger among participants with household support ON, at a marginally significant level, than those with household support OFF (P = .056, η2 = .07). CONCLUSION: This study showed feasibility, acceptability, and preliminary signals of efficacy of a remotely delivered intervention to facilitate adherence to dietary guidelines for cancer prevention and that coach monitoring and household support may be especially effective strategies. A fully powered clinical trial is warranted to test an optimized version of the intervention that includes nutrition education, self-regulation skills training, coach monitoring, and household member involvement. TRIAL REGISTRATION: ClinicalTrials.gov NCT04947150.

Overlapping and distinct relationships between hedonic hunger, uncontrolled eating, food craving, and the obesogenic home food environment during and after a 12-month behavioral weight loss program.

Hedonic hunger, reward-driven eating outside of biological need, is a newer construct in eating behavior research. During behavioral weight loss (BWL), greater improvements in hedonic hunger are associated with higher weight loss, but it remains unclear if hedonic hunger predicts weight loss independent of more well-established, similar constructs (uncontrolled eating and food craving). Research also is needed to understand how hedonic hunger interacts with contextual factors (e.g., obesogenic food environment) during weight loss. Adults (N = 283) in a 12-month randomized controlled trial of BWL were weighed at 0, 12, and 24 months, and completed questionnaires assessing hedonic hunger, food craving, uncontrolled eating, and the home food environment. All variables improved at 12 and 24 months. Decreases in hedonic hunger at 12 months were associated with higher concurrent weight loss, but not when accounting for improvements in craving and uncontrolled eating. At 24 months, reduction in craving was a stronger predictor of weight loss than hedonic hunger, but improvement in hedonic hunger was a stronger predictor of weight loss than change in uncontrolled eating. Changes to the obesogenic home food environment failed to predict weight loss, regardless of levels of hedonic hunger. This study adds novel information on the individual and contextual factors associated with short- and long-term weight control, which can help refine conceptual models and treatment strategies.

Do monthly coaching calls influence proximal participant adherence in a behavioral weight loss program?

Participants who receive continued coach contact following behavioral weight loss treatment are more successful in maintaining their weight loss long-term. The current study examines whether these contacts have dynamic effects, such that participants are most adherent to the prescribed weight loss behaviors in the days after the call, when motivation and goal salience may be heightened, than they are as time goes on. The current study examined the trajectory of calorie intake, physical activity, weight, and self-monitoring behavior in the fourteen days after a monthly coaching call among participants completing the maintenance phase of a behavioral weight loss trial. For physical activity outcomes, caloric intake, and weight, there were no changes across time. Participants did have the highest adherence and quality of dietary self-monitoring immediately after the call, which diminished over time. Coach contact may continually renew commitment to this burdensome but critical behavior. Likelihood of self-weighing showed an opposite trend, where participants were more likely to weigh themselves in the days more distal from the coach call. Results can inform the timing and content of future coach contact to promote weight control.

The Role of Physical Activity in Long-term Weight Loss: 36-month Results From a Randomized Controlled Trial.

BACKGROUND: Physical activity (PA) may promote long-term weight loss, but facilitating high levels of PA in behavioral weight loss programs is challenging. PURPOSE: This study reports the 36-month follow-up of a behavioral weight loss trial that tested the efficacy of increasing the emphasis on PA during treatment and using traditional or acceptance-based therapy (ABT) for this purpose. We also examined the extent to which long-term weight loss differed by PA pattern and tested if individual differences in eating behavior moderated this relationship. METHODS: Participants (N = 320) were randomized to (1) standard behavioral weight loss treatment (BT), (2) BT with a focus on PA, or (3) ABT with a focus on PA. Weight loss and PA were measured at 24- and 36-month follow-up. RESULTS: There were no differences between conditions in weight loss or PA at 24 or 36 months. Participants consistently engaging in high PA experienced the greatest weight losses. The positive impact of PA on weight loss was more pronounced among those with low emotional eating and those who believed that exercise did not affect their appetite. CONCLUSIONS: Findings emphasize the difficulty of improving long-term PA among adults with overweight/obesity beyond what standard behavioral weight loss treatment achieves. This study highlights the need to develop new PA treatment strategies, and suggests that ABT for weight loss may be more effective when applied to eating behavior versus PA. Results also demonstrate the importance of addressing problematic eating behavior and cognitions to fully realize the benefits of PA for weight loss. CLINICAL TRIAL INFORMATION: ClinicalTrials.gov identifier: NCT02363010.

Subjective experiences of physical activity and forecasting bias during behavioral weight loss.

Introduction: Engagement in physical activity (PA) is a critical component of behavioral weight loss (BWL) treatment. Subjective experiences surrounding PA may shape exercise decisions and need to be further understood within a BWL sample. Methods: Participants in this study were adults with overweight/obesity enrolled in an 18-month BWL program. At baseline, six, and 18 months, participants (N = 320) predicted how they would feel during a lab-based walking task and rated their experiences mid-walk and post-walk. They also completed self-report questionnaires assessing depressive symptoms and discomfort intolerance. Results and Discussion: Results indicated that exercise experience and expectations were more positive at later treatment points than at baseline. At each assessment point, post-walk ratings were more positive than mid-walk ratings, but pre-walk ratings did not differ from mid-walk ratings, suggesting BWL participants were relatively accurate in predicting their PA experience. These results suggest treatment-seeking adults with overweight/obesity feel most positive upon completion of PA, may not experience a forecasting bias as hypothesized and seem to have increasingly positive PA expectations and experiences as they proceed through treatment and lose weight. Lower discomfort intolerance and depressive symptoms were associated with more positive PA expectations and experiences. Understanding these individual differences in PA experience can inform intervention strategies.

Optimizing an mHealth Intervention to Change Food Purchasing Behaviors for Cancer Prevention: Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Dietary intake is a powerful modifiable factor that influences cancer risk; however, most US adults do not adhere to dietary guidelines for cancer prevention. One promising pathway for improving dietary adherence is targeting grocery shopping habits. Interventions might facilitate healthy grocery choices, with a combination of mHealth and traditional methods, by promoting the salience of dietary goals while shopping, enhancing motivation to make dietary changes, and increasing household support for healthy food purchasing. OBJECTIVE: This pilot study will assess feasibility and acceptability of intervention components designed to improve adherence to dietary guidelines for cancer prevention (preliminary aim). The primary aim of the study is to quantify the effect of each intervention component, individually and in combination, on dietary intake (primary aim) and grocery store food purchases (exploratory aim). Mediation analyses will be conducted to understand the mechanisms of action (goal salience, motivation, and household support-secondary aims). The overarching goal is to optimize an mHealth intervention to be tested in a future fully powered clinical trial. METHODS: The study enrolled adults (N=62) with low adherence to dietary recommendations for cancer prevention. In a 20-week program, all participants attend a nutrition education workshop and receive weekly educational messages through an app. A factorial design is used to test 4 intervention components: (1) location-triggered messages: educational messages are delivered when arriving at grocery stores; (2) reflections on the benefits of change: content is added to messages to encourage reflection on anticipated benefits of healthy eating, and participants attend an additional workshop session and 3 coach calls on this topic; (3) coach monitoring: food purchases are monitored digitally by a coach who sends personalized weekly app messages and conducts 3 coaching calls that focus on feedback about purchases; and (4) household support: another adult in the household receives messages designed to elicit support for healthy food purchasing, and support is addressed in 3 coach calls and an extra workshop session attended by the index participant and household member. Assessments are completed at weeks 0, 10, and 20 using self-report measures, as well as objective capture of grocery data from the point of purchase using store loyalty accounts. RESULTS: The National Cancer Institute funded this study (R21CA252933) on July 7, 2020. Participant recruitment began in the spring of 2021 and concluded with the successful enrollment of 62 participants. Data collection is expected to be completed in the summer of 2022, and results are expected to be disseminated in the summer of 2023. CONCLUSIONS: The results of this study will inform the development of scalable interventions to lower cancer risk via changes in dietary intake. TRIAL REGISTRATION: ClinicalTrials.gov NCT04947150; https://clinicaltrials.gov/ct2/show/NCT04947150. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39669.

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.

Counselor Surveillance of Digital Self-Monitoring Data: A Pilot Randomized Controlled Trial.

OBJECTIVE: This pilot study tested counselor access to participants' digital self-monitoring (SM) data as a means of improving long-term lifestyle modification (LM) outcomes. METHODS: After 12 weeks of weight-loss treatment, participants (N = 77) were randomized to LM or LM+SHARE for weeks 13 to 52. All participants received monthly phone calls and weekly text messages from weeks 13 to 52 and were instructed to engage in daily digital SM of weight, eating, and exercise. In LM+SHARE, but not LM, counselors had access to SM device data. Assessments were conducted as weeks 0, 13, 26, and 52. RESULTS: Retention, engagement, and treatment satisfaction were excellent. LM+SHARE participants, compared with LM, had more frequent SM of weight and eating. Weight loss continued at a similar rate in both conditions from weeks 13 to 26. From weeks 26 to 52, those in LM regained approximately 2 kg, whereas those in LM+SHARE maintained weight loss, a significant difference. Nonetheless, total weight loss did not significantly differ by condition. Engagement in dietary SM mediated the effect of condition on weight. CONCLUSIONS: Counselor access to SM data is feasible and acceptable. Additional research is warranted to determine whether it can meaningfully improve outcomes.

Resting-state functional brain connectivity in a predominantly African-American sample of older adults: exploring links among personality traits, cognitive performance, and the default mode network.

The personality traits of neuroticism, openness, and conscientiousness are relevant factors for cognitive aging outcomes. The present study examined how these traits were associated with cognitive abilities and corresponding resting-state functional connectivity (RSFC) of the default mode network (DMN) in an older and predominantly minority sample. A sample of 58 cognitively unimpaired, largely African-American, older adults (M age = 68.28 ± 8.33) completed a standard RSFC magnetic resonance imaging sequence, a Big Five measure of personality, and delayed memory, Stroop, and verbal fluency tasks. Personality trait associations of within-network connectivity of the posterior cingulate cortex (PCC), a hub of the DMN, were examined using a seed-based approach. Trait scores were regressed on cognitive performance (delayed memory for neuroticism, Stroop for conscientiousness, and verbal fluency for openness). Greater openness predicted greater verbal fluency and greater RSFC between the PCC and eight clusters, including the medial prefrontal cortex, left middle frontal gyrus, and precuneus. Greater PCC-precuneus connectivity predicted greater verbal fluency. Neuroticism and conscientiousness did not significantly predict either cognitive performance or RSFC. Although requiring replication and elaboration, the results implicate openness as a contributing factor to cognitive aging via concomitant cognitive performance and connectivity within cortical hubs of the DMN and add to the sparse literature on these variables in a diverse group of older adults.